Malignant hypertension
Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignantMalignant hypertension is very high blood pressure 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:
- Collagen vascular disorders (such as systemic lupus erythematosus, systemic sclerosis, and periarteritis nodosa)
- Kidney problems
- Pregnancy-induced high blood pressure (toxemia)
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
Symptoms
Symptoms of malignant hypertension include:
- Blurred vision
- Change in mental status, such as anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, or stupor
- Chest pain (feeling of crushing or pressure)
- Cough
- Headache
- Nausea or vomiting
- Numbness of the arms, legs, face, or other areas
- Reduced urine output
- Seizure
- Shortness of breath
- Weakness 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 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
Tests to determine damage to the kidneys may include:
- Arterial blood gas analysis
- BUN (blood urea nitrogen)
- Creatinine
- Urinalysis
- Kidney ultrasound
A chest x-ray may show congestion in the lungs and an enlarged heart.
This disease may also affect the results of these tests:
- Level of aldosterone (a hormone from the adrenal gland)
- Cardiac enzymes (markers of heart damage)
- CT scan of the brain
- Electrocardiogram (EKG)
- Renin 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 dialysis (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: heart attack, angina (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances
- Kidney failure
- Permanent blindness
- Fluid in the lungs
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.
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.
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.
