CEREBRAL COMPLICATIONS IN THE TREATMENT OF ACCELERATED HYPERTENSION

Abstract

The malignant phase of hypertension is irreversible unless treated, and rapid reduction of arterial pressure is the treatment of choice. In 10 patients with accelerated hypertension, abnormal neurological signs developed following the rapid reduction of arterial pressure by diazoxide. Three patients died without recovering from the neurological damage. A 4th died of an unrelated cause 1 mo. later. Areas of ischemic damage were found in the brains of 3 of these cases. Of the 6 survivors, 4 had residual neurological disability. These changes may result from loss of auto regulation of the cerebral circulation in patients with severe hypertension so that a rapid reduction in arterial pressure led to ischemia, especially of peripheral areas of the brain. Cerebrovascular autoregulation is likely to be compromised in patients with cerebral edema, stenosis of major cranial vessels or patients with long-standing severe hypertension. Blood pressure in patients with accelerated hypertension should be lowered gently over a period of several hours or days to allow time for the cerebrovascular autoregulatory mechanisms to recover.