Document Detail

Cerebral complications in the treatment of accelerated hypertension.
MedLine Citation:
PMID:  482589     Owner:  NLM     Status:  MEDLINE    
The malignant phase of hypertension is invariably fatal unless treated, and rapid reduction of arterial pressure is thought to be the treatment of choice. Ten patients with accelerated hypertension are described in whom abnormal neurological signs developed following the rapid reduction of arterial pressure. Three patients died without recovering from the neurological damage. A fourth died of an unrelated cause a month later. Areas of ischaemic damage were found in the brains of three of these cases. Of the six survivors, four were left with some permanent neurological disability. It is likely that these changes resulted from the inability of the cerebral circulation in patients with severe hypertension to autoregulate blood flow to the brain, so that a rapid reduction in arterial pressure led to ischaemia, especially of the watershed areas of the brain. Cerebrovascular autoregulation is likely to be compromized in patients with cerebral oedema, stenosis of major cranial vessels or in those patients with long-standing severe hypertension. It is suggested that the blood pressure in patients with accelerated hypertension should be lowered gently over a period of several hours or even days in order to allow time for the cerebrovascular autoregulatory mechanisms to recover.
J G Ledingham; B Rajagopalan
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Quarterly journal of medicine     Volume:  48     ISSN:  0033-5622     ISO Abbreviation:  Q. J. Med.     Publication Date:  1979 Jan 
Date Detail:
Created Date:  1979-11-21     Completed Date:  1979-11-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401027     Medline TA:  Q J Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  25-41     Citation Subset:  IM    
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Brain Diseases / etiology*
Brain Edema / etiology
Brain Ischemia / etiology
Cerebrovascular Circulation
Hypertension, Malignant / complications*,  drug therapy,  physiopathology
Middle Aged
Papilledema / etiology
Seizures / etiology
Time Factors
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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