Difference between hypertensive encephalopathy and malignant hypertension

Written by Li Qiang
Intensive Care Unit
Updated on March 26, 2025
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The difference between hypertensive encephalopathy and malignant hypertension can be discerned from their names, indicating they are different conditions. Hypertensive encephalopathy refers to a condition where blood pressure rises sharply in a short period, with diastolic pressure exceeding 120 mmHg and systolic pressure exceeding 200 mmHg. This dramatic increase in blood pressure causes cerebral vasospasm and increased cerebral perfusion pressure, leading to various manifestations of cerebral edema, primarily severe headache, nausea, vomiting, seizures, and even brain herniation. The emphasis is on the rapid rise in blood pressure over a short term and its impact on the brain, specifically cerebral edema. Malignant hypertension also involves a rapid increase in blood pressure to extremely high levels over a short period. However, the focus of malignant hypertension is on the impact on multiple organs throughout the body, including the brain, but also severely affecting the heart, potentially causing acute left heart failure and pulmonary edema. In the kidneys, it can lead to acute renal failure, characterized by reduced urine output or anuria. Thus, malignant hypertension emphasizes the effects on multiple vital organs, whereas hypertensive encephalopathy focuses primarily on the impact on the brain and central nervous system. Hence, there are some distinctions between the two conditions.

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Written by Wei Shi Liang
Intensive Care Unit
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How to deal with hypertensive emergencies

Hypertensive emergency is characterized by a significant increase in blood pressure, often with diastolic pressure greater than 130 mmHg. Target organs including the brain, eyes, heart, and kidneys are severely compromised or fail. Hypertensive emergencies require admission to the CCU for cardiac monitoring and the use of intravenous antihypertensives. In the initial one to two hours, the reduction in blood pressure should not exceed 25% of the peak value. Control blood pressure within two to six hours and stabilize it at 160/100 mmHg. Commonly used antihypertensive drugs include sodium nitroprusside and nitroglycerin, while avoiding the use of nifedipine-like drugs for blood pressure reduction.

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Written by Li Hai Wen
Cardiology
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Is it called hypertension if the diastolic blood pressure is high?

High diastolic pressure, which is an increase in diastolic pressure, is also considered hypertension when the diastolic pressure exceeds 90mmHg. If you have hypertension, it is essential to have a formal medical examination at a hospital, such as blood tests for lipids and glucose to check for diabetes and hyperlipidemia. Blood tests are also done to evaluate liver and kidney functions, to see if there are any kidney diseases causing the increase in blood pressure. Additionally, under the guidance of a doctor, conduct ambulatory blood pressure monitoring to observe the overall situation of blood pressure increase within 24 hours. Based on the results of the blood tests and ambulatory blood pressure monitoring, determine whether antihypertensive medication is needed and which type of medication to use.

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Written by Liu Ying
Cardiology
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How to lower high blood pressure?

Hypertension is divided into primary hypertension and secondary hypertension. If it is secondary hypertension, removing the factors that cause high blood pressure can cure it. For example, if the hypertension is caused by an adrenal tumor, removing the tumor can normalize blood pressure. However, if diagnosed with primary hypertension, lifelong medication is required. There are many types of medications available, which need to be specifically analyzed based on the individual situation. If the patient primarily has high systolic pressure, it is recommended to use some calcium channel blockers, which are commonly used for elderly patients who primarily exhibit high systolic pressure. If it is primarily high diastolic pressure, some ACE inhibitors or ARBs are suggested. If sympathetic excitement is predominant, some β-blockers can be used. (Medication should be taken under the guidance of a professional doctor.)

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Obstetrics
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Pregnancy hypertension symptoms

The symptoms of hypertension during pregnancy vary depending on the blood pressure level, individual tolerance, and other factors. Common symptoms include high blood pressure, protein in the urine, and generalized edema. Edema can vary in severity; it can start with bilateral ankle swelling, progress to the calves, thighs, and then become generalized throughout the body. Increased blood pressure can also lead to headaches, dizziness, nausea, and blurred vision. In more severe cases, pain in the upper abdomen and convulsions may occur.

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Written by Chen Tian Hua
Cardiology
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How to lower high blood pressure

Patients with hypertension need to adopt a comprehensive approach to reduce their blood pressure, primarily comprising two aspects: On one hand, they should regulate their lifestyle for treatment purposes, which includes maintaining a long-term low-salt and low-oil diet, consuming more vegetables and fruits, regularly engaging in physical exercises and labor, keeping a healthy weight level, avoiding fatigue, not staying up late at night, and maintaining a good emotional state. On the other hand, suitable antihypertensive medications should be chosen based on the specific conditions of the patients and used long-term. If necessary, a combination of antihypertensive drugs may be required. Effective control of blood pressure can only be achieved by combining lifestyle adjustments with medication.