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Malignant hypertension

Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignant

Malignant hypertension is very high blood pressure that comes on suddenly and quickly.

High blood pressure

Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...

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    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:

    • Collagen vascular disorders (such as systemic lupus erythematosus, systemic sclerosis, and periarteritis nodosa)
    • Kidney problems
    • Pregnancy-induced high blood pressure (toxemia)

      Toxemia

      Preeclampsia is when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy.

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

      • Kidney failure
      • Renal hypertension caused by renal artery stenosis

        Renal hypertension

        Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called ren...

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        Symptoms

        Symptoms of malignant hypertension include:

        • Blurred vision

          Blurred vision

          There are many types of eye problems and vision disturbances, such as: HalosBlurred vision (the loss of sharpness of vision and the inability to see ...

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          • Change in mental status, such as anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, or stupor

            Anxiety

            Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...

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              Confusion

              Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...

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                Decreased alertness

                Decreased alertness is a state of reduced awareness. A coma is a state of decreased alertness from which a person cannot be awakened. A long-term co...

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                  Fatigue

                  Fatigue is a feeling of weariness, tiredness, or lack of energy.

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                    Restlessness

                    Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.

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                      Sleepiness

                      Drowsiness refers to feeling abnormally sleepy during the day. People who are drowsy may fall asleep in inappropriate situations or at inappropriate...

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                        Stupor

                        Decreased alertness is a state of reduced awareness. A coma is a state of decreased alertness from which a person cannot be awakened. A long-term co...

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                        • Chest pain (feeling of crushing or pressure)

                          Chest pain

                          Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

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                          • Cough

                            Cough

                            Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...

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                            • Headache

                              Headache

                              A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...

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                              • Nausea or vomiting

                                Nausea or vomiting

                                Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...

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                                • Numbness of the arms, legs, face, or other areas

                                  Numbness

                                  Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...

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                                  • Reduced urine output

                                    Reduced urine

                                    Decreased urine output means that you produce less urine than normal. Most adults make at least 500 mL of urine in 24 hours (a little over 2 cups)....

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                                    • Seizure

                                      Seizure

                                      A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...

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                                      • Shortness of breath

                                        Shortness of breath

                                        Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air

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                                        • Weakness of the arms, legs, face, or other areas

                                          Weakness

                                          Weakness is reduced strength in one or more muscles.

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                                          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 will reveal changes that indicate 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 retina

                                            Retina

                                            The retina is the light-sensitive layer of tissue at the back of the eyeball. Images that come through the eye's lens are focused on the retina. Th...

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                                            Tests to determine damage to the kidneys may include:

                                            • Arterial blood gas analysis

                                              Arterial blood gas analysis

                                              Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood.  They also determine the acidity (pH) of your blood.

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                                              • BUN (blood urea nitrogen)

                                                BUN

                                                BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...

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                                                • Creatinine

                                                  Creatinine

                                                  The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine can ...

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                                                  • Urinalysis

                                                    Urinalysis

                                                    Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...

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                                                    • Kidney ultrasound

                                                    A chest x-ray may show congestion in the lungs and an enlarged heart.

                                                    Chest x-ray

                                                    A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.

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                                                      This disease may also affect the results of these tests:

                                                      • Level of aldosterone (a hormone from the adrenal gland)

                                                        Aldosterone

                                                        The aldosterone blood test measures the level of the hormone aldosterone in blood. Aldosterone can also be measured using a urine test.

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                                                        • Cardiac enzymes (markers of heart damage)
                                                        • CT scan of the brain

                                                          CT scan of the brain

                                                          A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.

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                                                          • Electrocardiogram (EKG)

                                                            Electrocardiogram

                                                            An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

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                                                            • Renin level

                                                              Renin

                                                              The renin test measures the level of renin in blood.

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                                                              • 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 dialysis (machine that removes waste products from blood).

                                                              Dialysis

                                                              Dialysis treats end-stage kidney failure. It removes harmful substances from the blood when the kidneys cannot. This article focuses on peritoneal d...

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                                                                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: heart attack, angina (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances

                                                                  Heart attack

                                                                  Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...

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                                                                    Angina

                                                                    Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). Th...

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                                                                    • Kidney failure
                                                                    • Permanent blindness
                                                                    • Fluid in the lungs

                                                                      Fluid in the lungs

                                                                      Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of breath.

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                                                                      When to Contact a Medical Professional

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

                                                                      Call 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.

                                                                      Open References

                                                                      References

                                                                      Archbold A, Naish J. The cardiovascular system. In: Naish J, Court DS, eds. Medical Sciences. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 11.

                                                                      Bansal S, Linas SL. Hypertensive crisis: emergency and urgency. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 87.

                                                                      Kaynar AM. Arterial blood gas interpretation. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 36.

                                                                      Leung N, Textor SC. Vascular injury to the kidney. In: Fauci A , Kasper D, Longo DL, Hauser S, Jameson JL, Loscalzo J, eds. Harrison's Principals of Internal Medicine. 19th ed. New York, NY: McGraw Hill; 2015:chap 341.

                                                                      Shayne P, Lynch CA. Hypertensive crisis. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 69.

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                                                                        • Hypertensive kidney

                                                                          Hypertensive kidney - illustration

                                                                          The kidneys filter wastes and excrete fluid when the pressure of blood in the bloodstream forces blood through the internal structures of the kidney.

                                                                          Hypertensive kidney

                                                                          illustration

                                                                          • Hypertensive kidney

                                                                            Hypertensive kidney - illustration

                                                                            The kidneys filter wastes and excrete fluid when the pressure of blood in the bloodstream forces blood through the internal structures of the kidney.

                                                                            Hypertensive kidney

                                                                            illustration

                                                                          Related Information

                                                                           
                                                                          • Preeclampsia
                                                                          • Renovascular hypertension
                                                                          • Acute kidney failure
                                                                          • Stroke
                                                                          • Seizures
                                                                          • Decreased alertness
                                                                          • Heart attack
                                                                          • Angina
                                                                          • Pulmonary edema
                                                                          • High blood pressure
                                                                          • Stroke
                                                                          • Heart attack and acute coronary syndrome
                                                                           

                                                                          Review Date: 4/14/2017

                                                                          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 Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

                                                                          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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