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Alternative Names Return to topAccelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignant
Definition Return to top
Malignant hypertension is a sudden and rapid development of extremely high blood pressure. The lower (diastolic) blood pressure reading, which is normally around 80 mmHg, is often above 130 mmHg.
Causes Return to top
The disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy, and persons with kidney disorders or collagen vascular disorders.
You are at high risk for malignant hypertension if you have had kidney failure or renal hypertension caused by renal artery stenosis.
Symptoms Return to top
Exams and Tests Return to top
Malignant hypertension is a medical emergency.
A physical exam commonly shows:
An eye examination will reveal changes that indicate high blood pressure, including swelling of the optic nerve, retinal bleeding, narrowing of the blood vessels in the eye area, or other problems with the retina.
If not already present, kidney failure may develop as a complication of malignant hypertension. Other complications may also develop.
Tests to determine damage to the kidneys may include:
A chest x-ray may show lung congestion and an enlarged heart.
This disease may also alter the results of the following tests:
Treatment Return to top
You will need to stay in the hospital until the severe high blood pressure is under control. Medications will be given through a vein 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 will consider giving you medications to protect the heart if there is evidence of heart damage.
After the severe high blood pressure is brought under control, blood pressure medicines taken by mouth can control the hypertension. Your medication may need to be adjusted occasionally. Hypertension can be difficult to control.
Outlook (Prognosis) Return to top
Many body systems are in serious risk due to the extreme rise in blood pressure. Multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys may be damaged. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and kidney failure may develop, which may be permanent, requiring dialysis (kidney machine).
If treated promptly, malignant hypertension is often controlled without permanent complications. If it is not treated promptly, complications may be severe and life-threatening.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Go to the emergency room or call your local emergency number (such as 911) if symptoms of malignant hypertension develop. This is an emergency condition.
Call your health care provider if you know you have poorly controlled high blood pressure.
Prevention Return to top
If you have high blood pressure, carefully monitoring your blood pressure and taking your medicines properly help to reduce the risk. Eat a healthy diet, one that is low in salt and low in fat.
References Return to top
Badr KF, Brenner BM. Vascular injury to the kidney. In: Fauci A , Kasper D, Longo DL, et al, eds. Harrison's Principals of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008:chap 280.Update Date: 4/20/2009 Updated by: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.