Résumé
L’hypertension artérielle (HTA) maligne est une entité nosologique définie par une élévation brusque de la pression artérielle associée à une rétinopathie de grades III ou IV. Si son incidence a diminué au cours des dernières décennies, le pronostic en l’absence de traitement adapté reste sombre. La compréhension de la physiopathologie et du rôle prépondérant du système rénine angiotensine aldostérone dans la genèse et la pérennisation de l’HTA maligne a permis l’amélioration du pronostic avec le recours aux inhibiteurs de ce système. L’enjeu est de différencier une élévation tensionnelle simple sans retentissement viscéral (hypertensive urgencies) d’une élévation tensionnelle contemporaine d’une souffrance d’organe, qui nécessite un contrôle rapide de la pression artérielle (hypertensive emergencies). Cette revue a pour but de guider le clinicien dans sa démarche de diagnostic positif et étiologique et de présenter les possibilités thérapeutiques à sa disposition.
Abstract
Malignant hypertension is defined by a rise in blood pressure associated with stage III or IV retinopathy. This situation remains rare but may have a fatal issue if not recognized and treated appropriately. The understanding of the pathogenesis of malignant hypertension with the importance of renin angiotensin aldosteron system activation allowed for an improvement in early and long term outcomes. The key point is to determine whether the rise in blood pressure is associated with organ failure or not, to differentiate hypertensive urgencies from emergencies. In hypertensive emergencies, the rapid introduction of antihypertensive drugs is recommended. The aim of this review is to propose guidance for malignant hypertension diagnosis, cause assessment, and treatment.
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Demiselle, J., Beloncle, F., Asfar, P. et al. Hypertension artérielle maligne. Réanimation 24, 165–171 (2015). https://doi.org/10.1007/s13546-015-1051-9
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DOI: https://doi.org/10.1007/s13546-015-1051-9