THE NATURE OF MALIGNANT HYPERTENSION

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Abstract
Malignant hypertension is a syndrome which may occur with no evidence of previously existing hypertension; as the end stage of essential hypertension, with or without uremia; as the end stage of a miscellaneous group of conditions characterized by secondary hypertension. It is usually impossible to decide during life whether the hypertension is primary, or secondary to some unrecognized morbid process. The renal pathological findings show wide variation from patient to patient. The presence of acute necrotizing arteriolitis does not establish the diagnosis of primary malignant hypertension nor does its absence rule it out. The prognosis is almost always poor. Exceptions are apparently found in those rare surgically amenable instances in which the syndrome is precipitated by renal infarction or the development of certain tumors of the adrenal glands. In rare cases of apparently typical malignant hypertension remission of symptoms and resolution of the retinitis may occur; the blood pressure, however, remains unchanged. After a period of 4-8 yrs., the downhill course again becomes manifest with fatal termination as in other cases of malignant hypertension.