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Malignant hypertension

Definition

Malignant hypertension is usually defined as very high blood pressure with swelling of the optic nerve behind the eye. The swelling of the optic nerve behind the eye is called papilledema.

Alternative Names

Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant

Causes, incidence, and risk factors

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

• Abnormal sensation (numbness) of the arms, legs, face, or other areas
• Blurred vision
• Change in mental status
  • Restlessness
  • Anxiety
  • Decreased alertness, decreased ability to concentrate
  • Fatigue
  • Sleepiness, stuporous, lethargic
  • Confusion
• Chest pain
  • Mid-chest location most common
  • Crushing or pressure sensation
• Cough
• Decreased urinary output
• Headache
• Nausea or vomiting
• Seizure
• Shortness of breath
• Weakness of the arms, legs, face, or other areas

Signs and tests

Malignant hypertension is a medical emergency.

Blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure, including swelling of the optic nerve, retinal bleeding, 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:

• BUN
• Creatinine
• Arterial blood gas analysis
• Urinalysis

A chest x-ray may show lung congestion. The congestion results from fluid forced into the lungs by heart failure as a consequence of the high blood pressure.

This disease may also alter the results of the following tests:

• Aldosterone
• Renin
• Urinary casts

Treatment

You will need to stay in the hospital until the severe high blood pressure is under control. Medications may be given through a vein to reduce your blood pressure.

After the severe high blood pressure is brought under control, blood pressure medicines taken by mouth can control the hypertension. The medication may need to be adjusted occasionally. Hypertension can be difficult to control.

Expectations (prognosis)

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 sustain damage. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and kidney failure may develop, which may be permanent.

If treated promptly, malignant hypertension is often controlled without permanent complications. If it is not treated promptly, complications may be severe and life-threatening.

Complications

• Brain damage due to:
  • Coma
  • Hypertensive encephalopathy
  • Intracerebral hemorrhage
  • Seizures
  • Spasm or constriction of the arteries of the brain
  • Stroke
  • Swelling
• Heart damage, including:
  • Heart attack
  • Angina
• Kidney failure
• Malignant hypertension episodes return
• Permanent blindness
• Pulmonary edema

Calling your health care provider

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

If you have high blood pressure, carefully monitoring your blood pressure and taking your medicines properly help to reduce the risk.

Review Date:8/14/2007
Reviewed By:Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network.

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