Malignant hypertension presenting as hemolysis, thrombocytopenia, and renal failure

This case review describes a patient presenting to the emergency department with malignant hypertension, a medical emergency occurring in up to 1% of the hypertensive population. The features of malignant hypertension resemble those of other diseases. For example, the association between red-cell fragmentation and malignant hypertension is thought to be due to endothelial injury and fibrinoid necrosis, which promote hemolysis, platelet destruction, and varying degrees of renal failure, resulting in a clinical picture similar to that of thrombotic thrombocytopenic purpura. Resolving the hemolysis and improving the renal function can only be achieved through rapid and effective control of the blood pressure. Without treatment, the survival rate for malignant hypertension is 10% to 35%. With appropriate treatment, the 5-year survival rate is 75%.