The accelerated ("malignant") form of hypertension is characterized by the presence of pathological changes indicative of a widespread necrotizing arteriolitis. Strong but not certain evidence for this diagnosis may be obtained on clinical grounds, particularly when patients are encountered with established diastolic hypertension, with rapidly progressive renal damage, and usually—although not necessarily—with retinopathy and papilledema.
Separation of the accelerated form from other types of hypertension was made by Volhard and Fahr, in 1914.1 Since that time there have been numerous descriptions of its clinical features and its rather uniform rapidly downhill course.2-5 It is accepted generally that this condition occurs infrequently de novo, appearing more often after the previous development of primary (essential) or secondary hypertension.
Discussion continues as to whether one is dealing with a phase dependent solely upon the intensity of the hypertensive process or whether a superimposed and qualitatively different mechanism is responsible.6 The