Abstract: PUB050
Extreme Malignant Hypertension Resulting in Dialysis-Dependent Hypertensive Nephrosclerosis
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Al Mubaid, Ahmed, Prime Olympia Fields, Olympia Fields, Illinois, United States
- Arby, Muzamil, Prime Olympia Fields, Olympia Fields, Illinois, United States
- Wagmeister, Sarah Nicole, Prime Olympia Fields, Olympia Fields, Illinois, United States
- Sarguroh, Tauseef A., Kidney Care Center, Olympia Fields, Illinois, United States
Introduction
Malignant hypertension is a life-threatening condition characterized by severe blood pressure (BP) elevation with acute target-organ injury requiring prompt but controlled BP reduction.
Case Description
A 56-year-old woman presented with worsening headaches and progressive visual disturbances. BP measurements repeatedly demonstrated systolic pressures in the 300s with diastolic pressures between 120–130 mmHg despite repeated automated and manual confirmation. A left radial arterial line confirmed a BP of 327/149 mmHg with mean arterial pressure of 211 mmHg. Laboratory studies demonstrated potassium 2.9 mmol/L, blood urea nitrogen 117 mg/dL, creatinine 11.7 mg/dL, elevated troponin, and significant proteinuria. Computed tomography angiography demonstrated no evidence of aortic pathology, coarctation, or renovascular disease. Secondary hypertension evaluation including aldosterone-renin ratio, ANCA, dsDNA, HIV testing, and urine metanephrines was unrevealing. The patient was admitted to the intensive care unit and treated with intravenous nicardipine infusion with continuous arterial-line monitoring to allow gradual guideline-directed BP reduction. Renal function failed to recover and intermittent hemodialysis was initiated on hospital day 3. She was transitioned to oral antihypertensive therapy including lisinopril, nifedipine, spironolactone, and carvedilol. BP improved to 138/91 mmHg by hospital day 6; however patient remained dialysis-dependent.
Discussion
Malignant hypertension remains a severe hypertensive emergency associated with substantial cardiovascular and renal morbidity. Continuous arterial-line monitoring allowed accurate confirmation of extreme hypertension and precise titration of antihypertensive therapy while minimizing the risk of rapid overcorrection. This case highlights the relationship between severe uncontrolled hypertension and irreversible renal injury. Despite successful BP reduction, renal recovery may not occur once critical nephron mass is lost. Early recognition, medication adherence, and longitudinal BP control remain essential to preventing catastrophic renal outcomes.