ORIGINAL PAPERS: TreatmentThe pharmacological management of malignant hypertensionGosse, Philippea; Boulestreau, Romainb; Brockers, Camillea; Puel, Charlottea; Rubin, Sebastienc; Cremer, AntoineaAuthor Information aHypertension Unit, University Hospital of Bordeaux, Hôpital Saint André, Bordeaux bCardiology Department, Hospital of Pau, Pau cNephrology Department, University Hospital of Bordeaux, Bordeaux, France Correspondence to Philippe Gosse, Hypertension Unit, University Hospital of Bordeaux, Hôpital Saint André, 1 Rue Jean Burguet, 33075 Bordeaux, France. Tel: +33 556795889; e-mail: [email protected] Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; BP, blood pressure; MHT, malignant hypertension; RAS, renin–angiotensin system Received 28 April, 2020 Revised 14 May, 2020 Accepted 14 May, 2020 Journal of Hypertension: November 2020 - Volume 38 - Issue 11 - p 2325-2330 doi: 10.1097/HJH.0000000000002547 Buy Metrics Abstract Malignant hypertension (MHT) still remains a severe condition that requires early recognition and treatment. Over the years, the prevention and treatment of MHT have significantly advanced through the introduction of modern antihypertensive agents. However, in the absence of robust clinical trials, there remain no formal guidelines on the treatment of MHT. This review summarizes the historical background and pathophysiological evidence of MHT, which has led to common practices in its pharmacological management but can also introduce challenges. The current consensus for treatment involves early intravenous infusion of antihypertensive agents, but oral blockers of the renin–angiotensin system may improve the management of MHT, and it offers a suitable treatment option in low-income countries where the condition remains relatively prevalent. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.