Hypertensive Syndromes Sometimes Misdiagnosed As Hypertensive Crises

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Severe uncomplicated hypertension (Severe hypertension without hypertensive neuroretinopathy or acute end-organ dysfunction, formerly known as urgent hypertension) Benign hypertension with chronic end-organ complications Chronic renal insufficiency from primary renal parenchymal disease Chronic congestive heart failure from systolic or diastolic dysfunction Atherosclerotic coronary vascular disease (previous myocardial infarction, stable angina) Cerebrovascular disease (history of transient ischemic attack or cerebrovascular accident)

Hypertensive syndromes sometimes misdiagnosed as hypertensive crises. It should be noted that the finding of severe hypertension does not always imply the presence of a hypertensive crisis. In patients with severe uncomplicated hypertension (formally known as urgent hypertension) in which severe hypertension is not accompanied by evidence of malignant hypertension or acute end-organ dysfunction, eventual complications due to stroke, myocardial infarction, or congestive heart failure tend to occur over months to years, rather than hours to days. Long-term control of blood pressure can prevent these eventual complications. However, a hypertensive crisis cannot be diagnosed because no evidence exists that acute reduction of blood pressure results in improvement in short- or long-term prognosis. Moreover, the presence of chronic hypertensive end-organ complications in a patient with nonmalignant hypertension does not imply the existence of a hypertensive crisis requiring rapid control of blood pressure. The category of benign hypertension with chronic complications includes hypertensive patients with chronic renal insufficiency due to underlying primary renal parenchymal disease, chronic congestive heart failure as a result of either systolic or diastolic dysfunction, atherosclerotic coronary vascular disease (stable angina or previous myocardial infarction), or chronic cerebrovascular disease (previous transient ischemic attacks or cerebrovascular accident). Long-term inadequate blood pressure control increases the risk of further deterioration of endorgan function in each of these conditions. However, no evidence exists that rapid control of blood pressure is necessary to prevent further complications. Therefore, a true hypertensive crisis does not exist.

Pathophysiology of malignant hypertension

Pathophysiology of malignant hypertension

Low potassium diet

Lumen

Low potassium diet

Renal ischemia

Denudation of epithelium

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