The term malignant hypertension was first used by Volhard and Farh in 1914 after noting that many patients with severe hypertension had fundoscopic changes such as retinopathy and papilledema in addition to renal insufficiency.
They defined malignant hypertension as an elevated blood pressure with signs of acute end-organ damage.
Malignant hypertension displays severe arterial changes such as concentric onion skin lesion and thickening of the intima by smooth muscle cells and fibroblasts, so called hyperplastic endoarteritis.
The vascular injury is characterized by fibrinoid necrosis and proliferative endarteritis. It is a hypotensive emergency associated with ischemic retinal changes consistent with grades III or IV hypertensive retinopathy.
If malignant hypertension is left untreated, around 8 percent of patients die within 2 years, hence the name.
The importance of early diagnosis is emphasized as patients tend to develop clinical symptoms only at a late stage of their disease.
Malignant hypertension
