Figure 84

Distribution of vascular lesions in malignant hypertension. Malignant hypertension is essentially a systemic vasculopathy induced by severe hypertension. Fibrinoid necrosis and proliferative endarteritis occur throughout the body in numerous vascular beds, leading to ischemic changes. In the retina, striate hemorrhages and cotton-wool spots develop. The finding of hypertensive neuroretinopathy is the clinical sine qua non of malignant hypertension. Vascular lesions in the gastrointestinal tract (GI) can lead to hemorrhage or bowel necrosis. Hemorrhagic pancreatitis also can occur. Cerebrovascular lesions can lead to cerebral infarction or intracerebral hemorrhage. Hypertensive encephalopathy also can develop as a result of failure of autoregulation with cerebral overperfusion and edema (Fig. 8-22). Vascular lesions also can develop in the myocardium; however, acute hypertensive heart failure is largely the result of acute diastolic dysfunction induced by the marked increase in afterload that accompanies malignant hypertension (Figs. 824 and 8-25). CNS—central nervous system.

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