P-330: Malignant hypertension (MHT) : A systematic therapeutic approach through blockade of renin angiotensin system

• Published in: American journal of hypertension 2004-05, Vol.17 (S1), p.155A-155A
• Main Authors: Herbland, Alexandre, Lasserre, Raphael, Lemetayer, Philippe, Clementy, Jacques, Gosse, Philippe
• Format: Article
• Language: English
• Subjects: Antihypertensive Treatment; Malignant Hypertension; Renin-Angiotensin System
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2004.03.405

Despite MHT is a potentially fatal form of hypertension (HT), no study has shown superiority of one therapeutic strategy compared to another one. The pathogenesis of MHT seems to be based on a failure in the usual feedback mechanisms of renin-angiotensin-aldosterone system (RAAs) whereby aldosterone usually causes sodium retention which in turn inhibits renin secretion. ACE-inhibitors, Beta blockers (BB), and angiotensin II receptor blockers (ARBs) inhibit the RAAs at different levels. The place of these drugs in this indication has not been well established. The aims of this study were to assess a standard therapeutic strategy based on the physiopathology of MHT and study evolution of clinical and paraclinical characteristics of a cohort of patients admitted for MHT. All patients admitted in the unit with diagnosis of MHT (severe HT, hypertensive retinopathy grade III or IV Keith-Wagener-Barker) were treated with the same protocol: 1/ lisinopril 5 mg per os, progressively increased up to 40 mg in the following 72 hours if blood pressure (BP) was not controlled 2/ In case of failure, a BB per os was administered 3/ in third line, we added an ARBs. Central antihypertensive drugs, calcium channel antagonists could be used in fourth line. Diuretics were excluded as possible. Biological, clinical, electrocardiographic characteristics of patients were recorded at admission, and at distance during following-up. A total of 42 patients were admitted for MHT between 1995 and 2002. 27 men and 15 women, the mean age was 43± 11 years. 29 patients were followed up in the unit for a period of 22 ± 21 months. The mean systolic BP decreased from 196± 35 to 136± 21 mmHg, and the mean diastolic BP decreased from 113± 22 to 83± 10 mmHg The serum creatinine levels decreased from 176± 120 to 153± 64 m mol/l. The mean Sokolow score was 36± 13 mm at admission, and 26± 10 mm at follow-up. One patient died and one progressed to renal haemodialysis. The present study shows that the therapeutic strategy applied to treat MHT based on the physiopathology of MHT is well tolerated, permits a decrease in BP, a preservation of renal function, and a reduction of electrocardiographic signs of left ventricular hypertrophy. This strategy seems to be effective in both acute and long-term management of MHT. Am J Hypertens (2004) 17, 155A–155A; doi: 10.1016/j.amjhyper.2004.03.405