What is Malignant Hypertension?

    Hypertension (high blood pressure) is a common condition that affects one in three Americans (CDC, 2012). High blood pressure is diagnosed if your blood pressure is over 120 systolic and/or 80 diastolic (120/80 mmHg). High blood pressure is generally manageable, as long as you follow your doctor’s advice.

    Although not common, some people with high blood pressure may have rapid increases in blood pressure above 180 systolic and/or 120 diastolic (180/120). This is known as malignant hypertension. This condition is sometimes referred to as arteriolar nephrosclerosis.

    Malignant hypertension requires immediate medical attention. If emergency treatment is not provided, you may develop serious health problems, such as a heart attack, brain damage or kidney failure.

    What Causes Malignant Hypertension?

    Malignant hypertension mostly occurs in patients with a history of high blood pressure. It is especially common in patients whose blood pressure is above 140/90. According to the National Institutes of Health, about one percent of people with high blood pressure develop malignant hypertension (NIH, 2012).

    Some health issues increase your chances of developing malignant hypertension. These include:

    • kidney disorders or kidney failure
    • use of drugs like cocaine, amphetamines, oral contraceptives, or monoamine oxidase inhibitors (MAOIs), which are a class of anti-depressant medication
    • pregnancy and preeclampsia (when pregnant female develops high blood pressure and protein in the urine in late 2nd-3rd trimester of pregnancy)
    • autoimmune diseases (result of the body making antibodies against its own tissues)
    • spinal cord injuries causing over activity of parts of the nervous system
    • renal stenosis (narrowing of the arteries of the kidneys)
    • narrowing of the aorta, the main blood vessel leaving the heart, or aortic dissection (bleeding along the wall of the aorta)
    • not taking your medication for high blood pressure

    Malignant hypertension is also more common in African Americans, males, and individuals who smoke.

    What Are the Symptoms of Malignant Hypertension?

    High blood pressure is commonly referred to as the “silent killer” because it doesn’t always have obvious signs or symptoms. Unlike high blood pressure, malignant hypertension produces very noticeable symptoms that include:

    • changes in vision including blurred vision
    • chest pain
    • cough
    • anxiety
    • nausea or vomiting
    • numbness or weakness in the arms, legs, and/or face
    • shortness of breath
    • headache
    • reduced urine output

    Malignant hypertension can also result in a condition known as hypertensive encephalopathy. Symptoms of this disorder include:

    • headache
    • blurry vision
    • confusion
    • lethargy
    • seizure

    These symptoms may not be due to malignant hypertension. They may be related to other health conditions that are less serious. However, malignant hypertension is so serious, if you experience these symptoms you should seek emergency medical help. Your doctor will be able to provide you with more information about your condition.

    How Is Malignant Hypertension Diagnosed?

    Your doctor will ask you about your health history including treatment for high blood pressure. Your doctor will also measure your blood pressure. This will help to determine whether or not emergency treatment is needed.

    Determining Organ Damage

    Other tests may be used to see if your condition has resulted in organ damage. For instance, blood tests measuring BUN and creatinine levels may be ordered. BUN is blood urea nitrogen, which measures the amount of waste product form the breakdown of protein in the body. Creatinine is a chemical produced by breakdown of muscles that is cleared from the blood by the kidneys. When the kidneys are not functioning normally, these tests will be abnormal. Your doctor may also order the following:

    • an echocardiogram or ultrasound to look for heart damage
    • a urine test to measure proteins caused by kidney damage
    • an electrocardiogram (EKG) to measure the electrical functioning of the heart
    • a renal ultrasound to look for additional kidney problems
    • an eye exam to determine if damage to the eye has occurred

    How Is Malignant Hypertension Treated?

    Malignant hypertension is a medical emergency. Treatment must be provided immediately to lower blood pressure. Typically, treatment includes the use of intravenous high blood pressure medications. These medications are called antihypertensive medications. They are administered directly into the bloodstream through a vein in your arm for immediate action.

    Once your blood pressure has been stabilized, your doctor will prescribe oral blood pressure medications. These medications will enable you to control your blood pressure at home. If you are diagnosed with malignant hypertension, you will need to follow your doctor’s recommendations. This will include having regular check-ups to monitor your blood pressure.

    How Can Malignant Hypertension Be Prevented?

    Some cases of malignant hypertension can be prevented. If you have high blood pressure, it is important for you to check your blood pressure regularly. It is also important for you to take all prescribed medications without missing any doses. Take your medications and follow your doctor’s advice. Seek immediate treatment if the condition does occur. Urgent care will be necessary to help reduce organ damage.

    Tips to Lower Your Blood Pressure

    • adopt the Dietary Approaches to Stop Hypertension (DASH) diet, which includes eating fruits, vegetables, low-fat dairy products, foods high in potassium, whole grains, and avoiding or limiting saturated fat
    • limit your salt intake to 1,500 milligrams per day if you are African-American, over 50 years old, or have diabetes, hypertension, or chronic kidney disease; keep in mind that processed foods can be high in sodium
    • exercise for a minimum of 30 minutes each day
    • lose weight to get to a healthier weight for your height and body size
    • learn stress management techniques, such as deep breathing or meditation
    • quit smoking, if you smoke
    • limit alcoholic drinks to two per day if you’re a man and one drink per day if you’re female or over 65 years old
    • use a home blood pressure monitoring device to watch your blood pressure