Malignant hypertension is blood pressure that is so high that it is actually causing damage to organs, particularly in the nervous system, the cardiovascular system, and/or the kidneys. One type of such damage is called papilledema, a condition in which the optic nerve leading to the eye becomes dangerously swollen, threatening vision.
This is a serious condition that requires immediate care from your doctor. Rapid treatment can prevent long-term problems. Left untreated, damage from malignant hypertension occurs quickly and can be severe, involving organ damage to blood vessels, the eyes, heart, spleen, kidneys, and brain. In particular,
kidney failure
may develop since the blood vessels inside the kidneys are very sensitive to high blood pressure.
In addition to having
high blood pressure
, medical conditions leading to the development of malignant hypertension include:
History of kidney disorders or failureTaking certain drugs or medications, including cocaine, amphetamines, monoamine oxidase inhibitors (MAOIs), and oral contraceptivesHistory of collagen vascular diseases
Pregnant women with
preeclampsia
and eclampsia
PheochromocytomaSpinal cord disordersCoarctation or dissection of the aortaRenal artery stenosis or narrowing of the arteries to the kidneysMissing doses of prescribed antihypertensive medications, particularly beta-blockers or clonidine (Catapres), which can cause a rebound effect. Medication noncompliance is the most common reason for hypertensive emergencies.
A risk factor is something that increases your chance of getting a disease or condition. You are more likely to develop malignant hypertension if you have already have essential hypertension—high blood pressure of 140/90 or higher. Your risk may increase further if you are:
MaleAfrican AmericanA smoker
Malignant hypertension produces noticeable symptoms, including:
Chest painDifficulty breathingHeadacheVisual problemsNausea and vomitingNumbness/weakness of the legs, arms, face
In particular, malignant hypertension can lead to a condition called hypertensive encephalopathy. Symptoms of this condition include:
headache, vomiting, blurry vision with papilledema, mental changes like
anxiety
, confusion, fatigue, and seizure.
If you experience any of the above symptoms, do not assume it is due to malignant hypertension. These symptoms may be caused by other health conditions, including a
heart attack
or other less serious disorders. If you experience any one of them, see your physician.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your blood pressure readings will probably be very high. Readings will be taken in both arms, while lying down and while standing up. A careful stethoscope exam of your heart and a detailed neurological exam will be performed. An eye exam may show signs of high blood pressure, including swelling of the optic nerve or bleeding inside the eye.
Tests may include the following:
Blood tests for BUN and creatinine levels to check for kidney damageChest x-rayEchocardiogram or ultrasound of the heart to look for heart damageUrine tests for high levels of protein, small amounts of blood or abnormally high levels or certain hormonesEKG
to look at the heart’s electrical functioning
Renal duplex or
ultrasound
test of the kidney's arteries to look for blockage
Since malignant hypertension is a medical emergency, treatment needs to be received quickly. Treatment options include the following:
Intravenous high blood pressure medications–The specific medication will be chosen based on your specific situation, including whether you are suffering from damage to your kidneys or other organs. Possible medications may include:
Sodium nitroprusside or nitroglycerinBeta-blockersHydralazineLabetalolVasotec (enalapril) and ACE-inhibitorOral high blood pressure medicines once blood pressure has been lowered from dangerous levelsDialysis
If you are diagnosed with malignant hypertension, follow your doctor's
instructions
.
To help reduce your chance of developing malignant hypertension, take the following steps:
Frequently check your blood pressure levels.Report any sustained high blood pressure to your healthcare provider.Take all prescribed high blood pressure medicines regularly and avoid missing doses.