SPECIAL PROBLEMS OF MANAGEMENT OF SEVERE AND MALIGNANT HYPERTENSION

Combination of captopril and diuretics was used in management of 54 pa tients with malignant hypertension. Before treatment acute nitroprussi de test had been performed, Fluorescent angiography of fundal and peri limbal conjunctive vessels was used for the study of relationship betw een degree of blood pressure decrease, changes of clinical condition a nd the state of microcirculation in the eye. Blood pressure lowering b y 20-30% from initial level achieved by captopril (150 mg/day) was acc ompained by improvement of general well-being, reduction of symptoms o f encephalopathy and improvement of microcirculation in the eye. More profound blood pressure fall (by 35-40%) or more from initial level) d uring acute nitroprusside test or caused by overdosing of captopril le d to deterioration of clinical condition and worsening of disturbances of ocular microcirculation (increase in number of nonperfused vessels and appearance of new zones of ischemia).