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Malignant hypertension in blacks. Malignant intrarenal arterial disease as observed by light and electron microscopy
Insights
Malignant hypertension in US Black patients often presents differently than in European populations. The characteristic lesion is myxoid intimal thickening, not fibrinoid necrosis, in small arteries.
Area of Science:
- Nephrology
- Pathology
- Cardiovascular Medicine
Background:
- Malignant hypertension is a severe form of hypertension.
- Historically, fibrinoid necrosis of small arteries was considered the hallmark lesion.
- Previous studies predominantly focused on European populations.
Purpose of the Study:
- To investigate the characteristic vascular lesions in malignant hypertension among Black patients in the United States.
- To compare these findings with previously described lesions in other populations.
Main Methods:
- Histopathological examination of renal biopsies from patients with malignant hypertension.
- Analysis of vascular lesions, focusing on small arteries and arterioles.
Main Results:
- Patients in this series, predominantly Black, lacked typical fibrinoid necrosis.
- Atypical necrosis of small arteries was rare.
- The prominent lesion observed was myxoid intimal thickening of small arteries.
Conclusions:
- The characteristic renal vascular lesion in malignant hypertension among Black patients in the US differs from the classic description.
- Myxoid intimal thickening is a key feature in this population.
- Further research is needed to understand the implications of these distinct pathological findings.
Abstract:
Volhard and Fahr recognized that hypertensive intrarenal vascular disease could be divided into two groups corresponding to the clinical states of benign and malignant hypertension. Since that time, numerous papers on malignant hypertension, primarily dealing with European derived populations, have emphasized fibrinoid necrosis of small arteries and arterioles as the lesion of malignant hypertension, although some have also recognized a myxoid intimal lesion as characteristic. Today in the United States, however, a significant proportion of malignant hypertension occurs in blacks. In the present study, patients have lacked fibrinoid necrosis of arterioles and only rarely have had some atypical necrosis of small arteries. The prominent, but not pathognomonic, lesion in this series is a myxoid intimal thickening of small arteries consisting of smooth muscle cells, acid mucopolysaccharides, basement membrane-like materal, collagen, and other amorphous and unidentified material, probably plasma derived.