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Malignant hypertension

Definition

Malignant hypertension is very that comes on suddenly and quickly.

Causes

The disorder affects a small number of people with high blood pressure, including children and adults. It is more common in younger adults, especially African American men.

It also occurs in people with:

  • (such as systemic lupus erythematosus, systemic sclerosis, and periarteritis nodosa)
  • Kidney problems
  • Pregnancy-induced high blood pressure ( of pregnancy also called preeclampsia)

    • You are at high risk for malignant hypertension if you smoke and if you have had:

  • Kidney failure
  • caused by renal artery stenosis

    • Symptoms

    Symptoms of malignant hypertension include:

  • Change in mental status, such as , , , decreased ability to concentrate, , , , or
  • (feeling of crushing or pressure)
  • of the arms, legs, face, or other areas
  • output
  • of the arms, legs, face, or other areas

    • Exams and Tests

    Malignant hypertension is a medical emergency.

    A physical exam commonly shows:

  • Extremely high blood pressure
  • Swelling in the lower legs and feet
  • Abnormal heart sounds and fluid in the lungs
  • Changes in thinking, sensation, and reflexes

    • An eye exam may reveal changes that indicate very high blood pressure, including:

  • Bleeding of the retina (back part of the eye)
  • Narrowing of the blood vessels in the retina
  • Swelling of the optic nerve
  • Other problems with the

    • Tests to determine damage to the kidneys may include:

  • (blood urea nitrogen)
  • Kidney ultrasound

    • A may show congestion in the lungs and an enlarged heart.

    This disease may also affect the results of these tests:

  • Level of (a hormone from the adrenal gland)
  • Cardiac enzymes (markers of heart damage)
  • (ECG)
  • level
  • Urinary sediment

    • Treatment

    You will need to stay in the hospital until your severe high blood pressure is under control. You will receive medicines through a vein (IV) to reduce your blood pressure.

    If there is fluid in your lungs, you will be given medicines called diuretics, which help the body remove fluid. Your doctor may give you medicines to protect your heart if you have signs of heart damage.

    After your severe high blood pressure is under control, blood pressure medicines taken by mouth can control blood pressure. Your medicine may need to be changed sometimes. High blood pressure can be difficult to control.

    Outlook (Prognosis)

    Many body systems are at serious risk from the extreme rise in blood pressure. Organs including the brain, eyes, blood vessels, heart, and kidneys may be damaged.

    The blood vessels of the kidney are very likely to be damaged by high blood pressure. Kidney failure may develop, which may be permanent. If this happens, you may need (machine that removes waste products from blood).

    If treated right away, malignant hypertension can often be controlled without causing permanent problems. If it is not treated right away, it can be fatal.

    Possible Complications

    These complications may occur:

  • Brain damage (stroke, seizures)
  • Heart damage, including: , (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances
  • Kidney failure
  • Permanent blindness

    • When to Contact a Medical Professional

    Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of malignant hypertension. This is an emergency condition that can be life threatening.

    Contact your health care provider if you know you have poorly controlled high blood pressure.

    Prevention

    If you have high blood pressure, carefully monitor your blood pressure and take your medicines properly to help reduce your risk. Eat a healthy diet that is low in salt and fat.

    References

    Elliott WJ, Peixoto AJ, Bakris GL. Primary and secondary hypertension. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46.

    Greco BA, Umanath K. Renovascular hypertension and ischemic nephropathy. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 41.

    Levy PD, Brody A. Hypertension. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 70.

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    Review Date: 4/12/2023

    Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.