Abstract：
Malignant hypertension (MHT) is a hypertensive emergency with excessive blood pressure (BP) elevation and accelerated disease progression. MHT is characterized by acute microvascular damage and autoregulation failure affecting the retina, brain, heart, kidney, and vascular tree. BP must be lowered within hours to mitigate patient risk. Both absolute BP levels and the pace of BP rise determine risk of target-organ damage. Nonadherence to the antihypertensive regimen remains the most common cause for MHT, although antiangiogenic and immunosuppressant therapy can also trigger hypertensive emergencies. Depending on the clinical presentation, parenteral or oral therapy can be used to initiate BP lowering. Evidence-based outcome data are spotty or lacking in MHT. With effective treatment, the prognosis for MHT has improved; however, patients remain at high risk of adverse cardiovascular and kidney outcomes. In this review, we summarize current viewpoints on the epidemiology, pathogenesis, and management of MHT; highlight research gaps; and propose strategies to improve outcomes.
摘要：
恶性高血压（MHT）是一种高血压急症，伴有血压（BP）过度升高和疾病进展加速。MHT的特点是急性微血管损伤和影响视网膜的自动调节失败，大脑,心,肾,和血管树。必须在数小时内降低血压以减轻患者风险。绝对BP水平和BP上升的速度都决定了靶器官损害的风险。不坚持抗高血压方案仍然是MHT的最常见原因，尽管抗血管生成和免疫抑制剂治疗也可以引发高血压急症。根据临床表现，肠胃外或口服治疗可用于开始降低BP。MHT中基于证据的结果数据参差不齐或缺乏。通过有效的治疗,MHT的预后有所改善；然而，患者仍处于心血管和肾脏不良结局的高风险.在这次审查中,我们总结了当前关于流行病学的观点，发病机制，和MHT的管理；突出研究差距；并提出改善成果的策略。
