OBJECTIVES: To investigate the incidence, TOD of patients presenting with A/MH, and its management.  METHODS: A retrospective cohort analysis was carried out at our 2500 bedded tertiary care teaching hospital on patients admitted with essential HTN or hypertensive retinopathy  during 2010 with ICD – 10 ( I.10 /H 35 ) coding with no comorbidities, were considered for the study. A 4 – year follow-up to evaluate their clinical outcomes of those diagnosed with A/MH was carried. RESULTS:

Of the 480 in-patients diagnosed with essential HTN or hypertensive retinopathy, 52 (10.8%) were found to have Grade III HTN (ESH/ESC 2013) which were documented as A/MH. Male predominance was found to be higher with 63.5% with a mean age of 49.58 years (±13.6 SD) and mean BMI of 25.0 (±5.6 SD).The Mean Arterial Pressure on admission was found to be 166.3(±16.6) mmHg and on discharge found to be 122.5(±10.9)mmHg.  TOD was identified in 42 patients among them 22(42.3%) patients had retinal damage, 15(28.8%) had left ventricular failure, 2(3.8%) patients had renal damage and 3(5.7%) reported to have cerebral damage. CONCLUSIONS: Our experience suggests that malignant hypertension is still common, with a small proportion of hypertensive’s presenting each year. We consider ours is the first study to report the incidence of A/MH in patients previously diagnosed with essential HTN from an Indian sub-population. We observe through our study that diagnosis of A/MH is not fulfilling the standard criteria. Thus we strongly believe that patients presenting with BP > 180/110 mm Hg should undergo ophthalmic evaluation, before being diagnosed as A/MH.