The presentation of MH underlines a condition of elevated blood pressure, like the appearance of exudates on pores and wounds of the body. Optic discs begin to swell, in a condition known as papilledema, frequently coupled with signs of retinal hemorrhage. The subjects also show signs of increased intracranial pressure, like headache and vomiting, which are frequently followed by faintness or vertigo, anxiety, or agitation in a general altered mental status. The damage in kidneys usually results in hematuria, proteinuria, and acute renal failure.

Other classical signs of MH include chest pain, arrhythmias, epistaxis, dyspnea, and paresthesias. Sometime, chest pain might be so severe to require immediate use of antihypertensive drugs such as nifedipine and calcium channel blockers.

• Anemia

  Although she was steroid-resistant, over the next subsequent three years, she maintained normal renal function without anemia and thrombocytopenia. [ncbi.nlm.nih.gov]

• Fatigue

  […] cause: Chest pain Difficulty breathing Headache Visual problems Nausea and vomiting Numbness/weakness of the legs, arms, face Malignant hypertension can lead to hypertensive encephalopathy which can also cause: Mental changes like anxiety Confusion Fatigue [winchesterhospital.org]

  Symptoms and Signs Change in GCS / mental status: anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, stupor, lethargy Sign of increased ICP: Headache N&V Subarachnoid/ cerebral haemorrhage Seizure [almostadoctor.co.uk]

  […] if you have had: Kidney failure Renal hypertension caused by renal artery stenosis Symptoms of malignant hypertension include: Blurred vision Change in mental status, such as anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue [medlineplus.gov]

  […] have had: Kidney failure Renal hypertension caused by renal artery stenosis Symptoms Symptoms of malignant hypertension include: Blurred vision Change in mental status, such as anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue [ufhealth.org]

• Congestive Heart Failure

  […] an enlarged heart Chemicals secreted by your heart ventricles in congestive heart failure (B type Natriuretic Peptide and Troponin). [wikihow.com]

  Thrombocytopenia and hemolytic anemia were immediately improved by the beginning of these treatments, however renal insufficiency and proteinuria were deteriorated and congestive heart failure developed. [ci.nii.ac.jp]

  […] sensations The most common clinical presentations of hypertensive emergencies are cerebral infarction (24.5%), pulmonary edema (22.5%), hypertensive encephalopathy (16.3%), and congestive heart failure (12%). [2] Less common presentations include intracranial [en.wikipedia.org]

  Although long-term control of BP in this setting can prevent complications due to stroke, myocardial infarction, or congestive heart failure, there is no evidence that acute reduction of blood pressure results in any improvement in short or long term [renalandurologynews.com]

• Resistant Hypertension

  Additional Hypertension Types: Isolated Systolic, Malignant, and Resistant Isolated systolic hypertension, malignant hypertension, and resistant hypertension are all recognized hypertension types with specific diagnostic criteria. [everydayhealth.com]

  […] appeared promising in patients with heart failure. [14] A phase III trial with the second-generation device for resistant hypertension has been registered. [14] For more information, see Hypertension. [emedicine.medscape.com]

  although not currently approved for these indications, has been shown to be effective for treating proteinuria and as a possible adjunct for the treatment of resistant hypertension. [journals.lww.com]

  “Resistant hypertension is often associated with secondary hypertension.” [healio.com]

  […] levels and increased vascular resistance. [renalandurologynews.com]

• Weight Loss

  Takayasu's arteritis was diagnosed on the basis of clinical symptoms of weight loss and low grade fever in conjunction with elevated sedimentation rate and radiographic evidence of aortic and renal artery stenosis. [ncbi.nlm.nih.gov]

  If indicated, the patient should follow a diet that can induce weight loss. Activity Activity is limited to bedrest until the patient is stable. Patients should be able to resume normal activity as outpatients once their BP has been controlled. [emedicine.medscape.com]

  Presentation of hypertensive crisis The most common non-specific symptoms are: Chest pain Headache Blurred vision Weight loss Less common presenting symptoms include: Dizziness Nausea Dyspnea Fatigue Malaise Epigastric pain Polyuria Gross hematuria The [renalandurologynews.com]

• Dyspnea

  A 33-year-old male was admitted with a 6-day history of worsening dyspnea, chest distress, and diffused pitting edema accompanied by very high blood pressure (200/145 mm Hg). [ncbi.nlm.nih.gov]

  Figure 1 A 41-year-old woman with blurred vision and dyspnea was found to have severe hypertension (blood pressure, 240/125 mm Hg in both arms) and grade IV hypertensive retinopathy. [nejm.org]

  Cardiovascular damages include chest pain, orthopnea, paroxysmal nocturnal dyspnea, or edema. The most important sign of renal damage, instead, is the decrease in urine output. [symptoma.com]

  Symptoms of hypertension to ask about include headaches, eye pain, reduced visual acuity, focal neurological deficits, chest pain, shortness of breath, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and palpitations. [eyewiki.aao.org]

• Vomiting

  An 11-month-old girl presented with a history of failure to thrive, vomiting, polydipsia, polyuria and visual inattention. She was found to have malignant hypertension due to unilateral renal artery stenosis. [ncbi.nlm.nih.gov]

  […] complications -htn induced streoke -pregnancy associated htn clinical features of malignant hypertension: symptoms symptoms: confusion, headache,visual disturbance,seizures The brain shows manifestations of increased intracranial pressure, such as headache, vomiting [quizlet.com]

  The subjects also show signs of increased intracranial pressure, like headache and vomiting, which are frequently followed by faintness or vertigo, anxiety, or agitation in a general altered mental status. [symptoma.com]

  Clinical findings Headache, blurred vision, nausea, vomiting, lethargy. Risk groups Males, African Americans, hypertensive patients. [medical-dictionary.thefreedictionary.com]

• Nausea

  A 38-year-old male presented with nausea, vomiting, loss of appetite and oliguria for 2 weeks. He was diagnosed with hypertensive emergency with cardiac and renal dysfunction. [ncbi.nlm.nih.gov]

  […] heart block& dizziness I: Syndromesof coronary insufficiency C: Greater than first- degree heartblock, CHF Labetalol HCl - blocker 20-80 mg IV bolus, (maxim um dose, 300 mg 2-10 min 2-4 hr Hypoten- sion, nausea, itching, scalp tingling& dizziness I [slideshare.net]

  Clinical findings Headache, blurred vision, nausea, vomiting, lethargy. Risk groups Males, African Americans, hypertensive patients. [medical-dictionary.thefreedictionary.com]

  Symptoms and signs of chronic kidney disease may develop (eg, anorexia, nausea, vomiting, pruritus, somnolence or confusion), as may signs of end-organ damage secondary to hypertension. [msdmanuals.com]

• Hypertension

  […] in stable phase), who were compared with patients with treated "high-risk" hypertension (hypertension) and healthy controls. [ncbi.nlm.nih.gov]

• Chest Pain

  Other classical signs of MH include chest pain, arrhythmias, epistaxis, dyspnea, and paresthesias. Sometime, chest pain might be so severe to require immediate use of antihypertensive drugs such as nifedipine and calcium channel blockers. [symptoma.com]

  Chest pain requires lowering of BP. The former use of oral nifedipine, a calcium channel blocker, has been strongly discouraged because it has been noted to lead to serious and fatal hypotensive problems. [almostadoctor.co.uk]

  These complications may occur: Brain damage (stroke, seizures) Heart damage, including: heart attack, angina (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances Kidney failure Permanent blindness Fluid in the [medlineplus.gov]

  Possible Complications These complications may occur: Brain damage (stroke, seizures) Heart damage, including: heart attack, angina (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances Kidney failure Permanent [ufhealth.org]

• Vascular Disease

  Both conditions may be associated with collagen vascular diseases, such as systemic lupus erythematosus. We report a case of acute cardiac tamponade associated with malignant hypertension secondary to lupus nephritis. [ncbi.nlm.nih.gov]

  Malignant hypertension is a medical emergency and requires immediate therapy and… Read More excretory system In renal system disease: Vascular disease …is the condition known as malignant hypertension, or accelerated hypertension, which arises when the [britannica.com]

  Prognosis Patients with severe hypertensive retinopathy and arteriosclerotic changes are at increased risk for coronary disease, peripheral vascular disease, and stroke. [eyewiki.aao.org]

  stroke, peripheral vascular disease left ventricular hypertrophy diastolic dysfunction (due to increased afterload) aortic dissection (due to medial degeneration) intracerebral hemorrhage (due to medial degeneration, Charcot-Bouchard aneurysms) lacunar [radiopaedia.org]

• Cardiomegaly

  […] flame-shaped haemorrhages Narrowing of retinal blood vessels Papilloedema (this must be present for the diagnosis of malignant hypertension to be made) Hard exudates Cotton wool spots Investigations ABG BUN Creatinine Urinalysis CXR Congestion in the lung Cardiomegaly [almostadoctor.co.uk]

  Chest x-ray showed cardiomegaly. A non-contrast computed tomography scan of the brain did not show any sign of stroke (haemorrhage). [bjmp.org]

• Diastolic Hypertension

  Full blown syndrome characterized by diastolic hypertension >130 mmHg, papilledema retinopathy, encephalopathy, cardiovascular abnormality, and renal failure. [auanet.org]

  Systolic hypertension is more prevalent in the elderly and has a greater association with cardiovascular disease than diastolic hypertension. [clinicaladvisor.com]

• Hypertensive Retinopathy

  Malignant hypertension is the clinical syndrome of severe elevations in blood pressure and funduscopic hypertensive retinopathy, including bilateral flame-shaped hemorrhage and papilledema. [ncbi.nlm.nih.gov]

  Hypertensive retinopathy Classification and external resources ICD - 10 H 35.0 Hypertension may lead to multiple adverse effects to the eye. Hypertension can cause retinopathy, optic neuropathy, and choroidopathy,. [eyewiki.aao.org]

• Blurred Vision

  A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and hemoptysis. [ncbi.nlm.nih.gov]

  Clinical findings Headache, blurred vision, nausea, vomiting, lethargy. Risk groups Males, African Americans, hypertensive patients. [medical-dictionary.thefreedictionary.com]

  Figure 1 A 41-year-old woman with blurred vision and dyspnea was found to have severe hypertension (blood pressure, 240/125 mm Hg in both arms) and grade IV hypertensive retinopathy. [nejm.org]

  He complained of blurred vision without photophobia, headache and mild chest discomfort. His past medical history was unremarkable. The patient did not have any significant family history. [bjmp.org]

• Retinal Hemorrhage

  Examination revealed bilateral 360° hemorrhagic choroidal detachments without retinal hemorrhage or detachment. Choroidal hemorrhages underwent prompt resolution with blood pressure control. [ncbi.nlm.nih.gov]

• Cotton Wool Spots

  Cotton-wool spots, or cytoid bodies, are not exudates, but rather are retinal infarcts. Hypertensive optic neuropathy is a late finding. [ncbi.nlm.nih.gov]

  He had 4+ edema in both eyes with exudate and cotton wool spots, and no APD. [consultqd.clevelandclinic.org]

  Cotton wool spots (Figure 1 & 3) are caused by ischemia to the nerve fiber layer secondary to fibrinous necrosis and luminal narrowing. [eyewiki.aao.org]

• Flame-Shaped Hemorrhage

  Malignant hypertension is the clinical syndrome of severe elevations in blood pressure and funduscopic hypertensive retinopathy, including bilateral flame-shaped hemorrhage and papilledema. [ncbi.nlm.nih.gov]

  While Accelerated high blood pressure is condition with high blood pressure, target organ damage, on fundoscopy we have flame shaped hemorrhages, or soft exudates, but without papilledema. There are two things. [robertjrgraham.com]

  Pathophysiology Retinal hemorrhages (Figure 1-3) develop when necrotic vessels bleed into either the nerve fiber layer (flame shaped hemorrhage) or the inner retina (dot blot hemorrhage). [eyewiki.aao.org]

  Note the flame-shaped hemorrhages, soft exudates, and early disc blurring. [emedicine.medscape.com]

• Kidney Failure

  Organs including the brain, eyes, blood vessels, heart, and kidneys may be damaged. The blood vessels of the kidney are very likely to be damaged by high blood pressure. Kidney failure may develop, which may be permanent. [slu.adam.com]

  Heart failure. Stroke. Sudden kidney failure. Coma. [epainassist.com]

• Oliguria

  He presented with oliguria, renal failure, thrombocytopenia and haemolytic anaemia. He required several sessions of renal replacement therapy. [ncbi.nlm.nih.gov]

  Introduction Rapid ↑ in blood pressure due to vascular damage to renal vessels secondary to benign nephrosclerosis (most common cause) thrombotic thrombocytopenic purpura hemolytic-uremic syndrome Presentation Symptoms oliguria due to acute renal failure [step1.medbullets.com]

  Damages mainly regard the central nervous system with injuries like encephalopathy and seizures, the cardiovascular system with injuries like chest pain and aortic dissection, and the renal system with like oliguria and azotemia. [symptoma.com]

• Headache

  A 62-year-old man with a history of hypertension was referred secondary to bilateral temporal scotomas and persistent headache for 3 days. Symptoms began during an inpatient admission for malignant hypertension. [ncbi.nlm.nih.gov]

  […] visual disturbance,seizures The brain shows manifestations of increased intracranial pressure, such as headache, vomiting, and/or subarachnoid or cerebral hemorrhage. [quizlet.com]

  Headache / Neurology 27 Jun, 2017 0 Emily Garrett Introduction Malignant hypertension is very high blood pressure that comes on suddenly and quickly. The diastolic BP reading (normally 130mmHg, and systolic is usually >200mmHg. [almostadoctor.co.uk]

• Stroke

  Ea was calculated from stroke volume and systolic BP and adjusted by body area (EaI). [ncbi.nlm.nih.gov]

  […] progressive and fatal disease Risk groups ♂, African Americans, hypertensives Clinical Headache, blurred vision, N&V, lethargy Complications Stroke, MI, blindness, renal failure. [medical-dictionary.thefreedictionary.com]

  Malignant hypertension may be responsible for several complications such as stroke, a rupture of the walls of the aorta (aortic dissection) or acute renal failure. [health.ccm.net]

  "Management of acute ischaemic stroke: new guidelines from the American Stroke Association and European Stroke Initiative.". Lancet Neurol. vol. 2. 2003. pp. 698-701. Lip, GY, Beevers, M, Beevers, DG. [renalandurologynews.com]

• Seizure

  Abstract Malignant hypertension is an unusual but well described cause of seizures in pediatrics. It is a medical emergency that must be recognized and emergently treated to prevent morbidity and mortality. [ncbi.nlm.nih.gov]

  Call 911 Call 911 if you have any of these: Chest pain or shortness of breath Seizure (with no history of seizure disorder) When to seek medical care Call your doctor right away if you have any of the following: Moderate to severe headache Weakness in [saintlukeskc.org]

  Related Information Preeclampsia Renovascular hypertension Acute kidney failure Stroke Seizures Decreased alertness Heart attack Angina Pulmonary edema References Archbold A, Naish J. The cardiovascular system. In: Naish J, Court DS, eds. [slu.adam.com]

• Papilledema

  One specific type of emergency is malignant hypertension, in which there are exudates and/or retinal hemorrhages or papilledema. Besides effective and prompt treatment, it is mandatory to screen for secondary causes of the hypertension. [ncbi.nlm.nih.gov]

  […] change is important. rapid rise leads to rapid organ failure, whereas more gradual rise is better tolerated 1-htn emergency 2.htn urgency high BP complicated by organ failure -htn emergency with retinopathy (hemorrhage and exaudate) -htn emergency with papilledema [quizlet.com]

  Optic discs begin to swell, in a condition known as papilledema, frequently coupled with signs of retinal hemorrhage. [symptoma.com]

• Dizziness

  & intracranial pressure C: hepatic,renal insufficiency Nitrogly- cerin (IV) 5-100 mcg/kg/ min 2-5 min 3-5 min Head ache, dizziness, vomiting, methemgl- obin &tolerance I: coronary dis.,CHF C: CVA, Intracranial pressure Diazoxide ( IV) 1-3 (mg/kg) IV [slideshare.net]

  Some of the more common signs include: Blurry vision Headache Chest pain Irregular heartbeat Nosebleed Shortness of breath Tingling, numbness, burning, or prickly skin sensations Faintness or dizziness Reduced urine output Nausea or vomiting Altered mental [verywellhealth.com]

  When to seek medical care Call your doctor right away if you have any of the following: Moderate to severe headache Weakness in the muscles of your face, arms, or legs Trouble speaking Extreme drowsiness or confusion Restlessness, anxiety Fainting or dizziness [saintlukeskc.org]

  Other symptoms of malignant hypertension include: Blurred vision Chest pain ( angina ) Difficulty breathing Dizziness Numbness in the arms, legs, and face Severe headache Shortness of breath In rare cases, malignant hypertension can cause brain swelling [webmd.com]

As MH is a dangerous condition, its evaluation should be rapid. Medical history can be useful for a correct diagnosis of MH, especially when it indicates previous cases of hypertension. Anyway, all the examples of previous damage to the central nervous system, cardiovascular system, and renal system can support the diagnosis of MH. The neurological damages include blurry vision, dizziness, and loss of movement or sensation. Cardiovascular damages include chest pain, orthopnea, paroxysmal nocturnal dyspnea, or edema. The most important sign of renal damage, instead, is the decrease in urine output. It should be noted that many of these clinical manifestations might be caused by sympathomimetic drugs such as cocaine and LSD. Therefore, an investigation on the use of these drugs by the patients is paramount.

The most important physical examination to diagnose MH is blood pressure measurement, which should be performed on both arms. If a marked difference in blood pressure between the two arms is noted, aortic dissection should be taken into consideration as alternative diagnosis. Fundoscopic examination is particularly useful to detect ocular signs such as retinal edema and papilledema, while bedside neurologic exam cab be used to measure nerve functions. Clinicians are also advised to perform an assessment of the cardiopulmonary status, to detect the presence of additional signs such as murmurs, hearts sounds, or jugular venous distension, which might help them reach the final diagnosis.

Laboratory evaluation includes complete blood count, blood biochemical panel, and analysis of urine, but sometime also plasma rennin activity and aldosterone or metanephrine levels, if aldosterone or pheochromocytoma are suspected to have caused hypertension. Imaging studies, instead, can be used when hypertension is suspected to have been caused by other conditions such as aortic dissection, ischemic stroke or intracranial hemorrhage.

• Abnormal Renal Function

  Abnormal renal function at presentation still predicts worse outcome. South Asian ethnicity is also associated with better outcome, although mechanisms involved are yet to be established. [ncbi.nlm.nih.gov]

• Decreased Platelet Count

  Microangiopathic hemolytic anemia as evidenced by a decreased platelet count and either an increased lactate dehydrogenase or presence of schistocytes is common in patients with malignant hypertension and is strongly associated with renal dysfunction. [renalandurologynews.com]

• Left Ventricular Hypertrophy

  There was no inter-group difference in retinopathy (P=0.25), proteinuria (P=0.08), haematuria (P=0.56) and left ventricular hypertrophy (P=0.14). [ncbi.nlm.nih.gov]

  ventricular hypertrophy diastolic dysfunction (due to increased afterload) aortic dissection (due to medial degeneration) intracerebral hemorrhage (due to medial degeneration, Charcot-Bouchard aneurysms) lacunar infarcts, deep white matter ischemia [radiopaedia.org]

  ECG: left ventricular hypertrophy or left atrial enlargement. Subsequent investigations may include: CT/MRI scan of the head or kidneys. Plasma renin activity. [patient.info]

The use of antihypertensive drugs is the most important treatment for MH. There are many classes of antihypertensive drugs and their choice should be based on the etiology of the hypertensive crisis, the severity of the condition, and the usual blood pressure of the patient before the hypertensive crisis itself, as the patient can have a history of chronic hypertension and might not tolerate normal blood pressure. Sodium nitroprusside, injected intravenously, is especially used in the most urgent cases requiring immediate treatment, because of its prompt effect. Oral agents like captopril, clonidine, or prazosin are used instead in less urgent cases, because their action is much slower than that of sodium nitroprusside, even though it remains effective. If sodium nitroprusside is unavailable and the action of oral agents is not began yet, controlled bloodletting can be used as effective alternative measure.

MH might turn out to be particularly resistant when end stage renal failure occurs. In these cases the clinicians can consider non-pharmaceutical treatments such as surgical nephrectomy and laparoscopic nephrectomy. There is also a therapy under investigation based on the electrical stimulation of the carotid sinus which is showing promising results for the treatment of MH [18].

It should be remembered that blood pressure reduction should be smooth and limited to a certain range, otherwise it might precipitate coronary, cerebral, and renal ischemia as well as infarction [19].

If patients are treated in a proper manner with the appropriate antihypertensive therapy, the prognosis of MH is good, with a survival rate after 5 years from the MH episode of 70%. However, if treatment is neglected the prognosis of MH becomes bad, and patients have just a 10% to 20% survival rate after 1 year from the MH event. Mortality rate increases substantially when the MH is accompanied by renal failure [16] [17].

Many are the causes of MH, the most common of which is essential hypertension frequently undiagnosed or not properly treated [2]. Very common are also clinical conditions secondary to renal diseases and procedures, such as kidney transplant, renal artery stenosis, or acute glomerulonephritis [3] [4]. Other causes of MH include pregnancy-related eclampsia, hyperaldosteronism, and the conditions triggering excess circulating catecholamines like sympathomimetic drug intake or autonomic dysfunction after spinal cord injury [5].

The prevalence of hypertension is very high. In USA, 30% of the population suffer from hypertension [6] [7], while worldwide it has been estimated that around 26% of the population is affected by this cardiovascular condition. Statistical data show that 1% to 2% of these people will experience a hypertensive crisis at some point of their life [8] [9].

MH is much more frequent in men than women, and many studies reveal that it is more common in elderly and black people [2] [10] [11]. The prevalence of hypertension and MH is expected to increase substantially over the next few decades, due to aging of the global population. MH prevalence is also substantially favored by the lack of incurrence, absence of primary care and noncompliance with prescribed treatments [12] [13].

The factors underlying the development of hypertension and MH are still unclear and poorly understood. However, it is believed that the starting point of this process is the rise of systemic vascular resistance which increases blood pressure. This in turn brings about a mechanical stress and an endothelial injury which increases permeability, activates coagulation cascade and platelets, and causes fibrin deposition. In this condition, ischemia begins to develop and additional vasoactive mediators are released, which foster the ongoing injury. The systemic vasoconstriction caused by the volume depletion due to pressure natriuresis and the renin-angiotensin system activation brings about a decrease in blood flow towards vital organs, which then leads to the final consequent injury of the organs concerned.

Damages mainly regard the central nervous system with injuries like encephalopathy and seizures, the cardiovascular system with injuries like chest pain and aortic dissection, and the renal system with like oliguria and azotemia [11] [5] [14] [15].

Close outpatient follow-up for hypertension is the most important measure to avoid future episodes of MH. Therefore, patients are highly recommended to refer to a specialist to organize an effective preventive plan. The plan should also include a diet low in fat and daily physical activity, both well known to have beneficial effects on the entire cardiovascular system.

Malignant hypertension (MH) is defined by a systolic blood pressure greater than 210 mmHg and a diastolic blood pressure greater than 130 mmHg. It implies a rapid deterioration of vital organ function which brings about some severe clinical consequences such as encephalopathy, retinopathy, renal failure, and myocardial ischemia. MH is very similar to accelerated hypertension, both in terms of clinical outcomes and therapies involved, even though MH is characterized by the typical sign of papilledema, that is the swelling of the optic disc.

Malignant hypertension (MH) is a type of high blood pressure (hypertension) which results in the impairment of one or more organ systems, especially the central nervous system, the heart and vessels, and the kidneys. MH is defined by a systolic blood pressure greater than 210 mmHg and a diastolic blood pressure greater than 130 mmHg. There are many causes of MH, the most common of which is essential hypertension frequently undiagnosed or not properly treated. Very common are also clinical conditions secondary to kidney diseases and procedures, such as kidney transplant, artery stenosis, or acute glomerulonephritis.

Common signs and symptoms of MH are:

• Headache 
• Blurred vision 
• Vomiting
• Chest pain
• Cough
• Shortness of breath
• Nose bleeds
• Faintness or vertigo
• Anxiety
• Agitation
• Altered mental status

The use of antihypertensive drugs is the most important treatment for MH. There are many classes of antihypertensive drugs and their choice is based on the cause of the hypertensive crisis, the severity of the condition, and the usual blood pressure before the hypertensive crisis itself. 

Close follow-up for hypertension is the most important measure to avoid future episodes of MH. Therefore, patients are highly recommended to refer to a specialist to organize an effective preventive plan. The plan should also include a diet low in fat and daily physical activity, both well known to have beneficial effects on the entire cardiovascular system.

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3. Lip GY, Beevers M, Beevers G. The failure of malignant hypertension to decline: a survey of 24 years' experience in a multiracial population in England. J Hypertens. 1994;12:1297-1305. 
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19. Brewster LM, MD; Michael Sutters, MD (2006). "Hypertensive Urgencies & Emergencies - Hypertension Drug Therapy". Systemic Hypertension. Armenian Health Network, Health.am. Retrieved 2007-12-02.