Malignant Hypertension

(Hypertensive Emergency; Hypertensive Crisis; Hypertensive Urgency)

Definition

Malignant hypertension is blood pressure that is so high that it is damaging to the body. The brain, heart, blood vessels, eyes, and kidneys are most at risk.

This is a serious condition that will need immediate care. Rapid care can stop long-term problems. If it is not treated, malignant hypertension can quickly cause severe damage. It can lead to problems such as kidney failure or vision loss.

Cardiovascular System and Kidneys

Placement of Blood Pressure Cuff
Copyright © Nucleus Medical Media, Inc.

Causes    TOP

Poor management of high blood pressure may cause malignant hypertension. Other medical conditions that can lead to malignant hypertension include:

  • History of kidney disorders or failure
  • Taking certain drugs or medications, including:
    • Cocaine, amphetamines
    • Monoamine oxidase inhibitors (MAOIs)
    • Oral contraceptives
  • History of collagen vascular diseases
  • Pregnant women with preeclampsia and eclampsia
  • Pheochromocytoma
  • Spinal cord disorders
  • Coarctation or dissection of the aorta
  • Renal artery stenosis or narrowing of the arteries to the kidneys
  • Missing doses of medicine for high blood pressure, like beta-blockers or clonidine, which can cause a rebound effect

Risk Factors    TOP

Malignant hypertension is more common in:

  • Men
  • Smokers
  • People with high blood pressure 140/90 or higher

Symptoms    TOP

Malignant hypertension can cause:

  • Chest pain
  • Difficulty breathing
  • Headache
  • Visual problems
  • Nausea and vomiting
  • Numbness/weakness of the legs, arms, face

Malignant hypertension can lead to hypertensive encephalopathy which can also cause:

  • Mental changes like anxiety
  • Confusion
  • Fatigue
  • Seizure

Diagnosis    TOP

Your doctor will ask about your symptoms and past health. A physical exam will be done. Blood pressure will be taken in both arms. It will be taken while you are lying down and while standing up. If the readings remain high the doctor will do the following:

  • Listen to the heart
  • Test nervous system
  • Examine eyes for swelling or bleeding in the eye

To look for any damage that may have occurred your doctor may also order:

  • Blood tests and urine tests
  • Chest x-ray
  • Echocardiogram or ultrasound of the heart to look for heart damage
  • EKG
  • Renal duplex or ultrasound—to check blood flow in kidneys

Treatment    TOP

Treatment needs to be started quickly. Options will depend on what has been affected. Medication options include:

  • Blood pressure medicine given by IV. This method lets the medicine quickly reduce blood pressure. The medicine can help to open blood vessels and reduce the force of heart beat. Options may include:
    • Sodium nitroprusside or nitroglycerin
    • Beta-blockers
    • Other vasodilators
    • ACE-inhibitor
  • High blood pressure pills once blood pressure is in safer levels

Tests will be done to look for any damage that may have happened. A treatment plan will be made to keep blood pressure in healthy levels.

Prevention    TOP

If you have high blood pressure, you can decrease your chance of malignant hypertension with the following step:

  • Check your blood pressure levels often
  • Report regular high blood pressure to your doctor or care team
  • Take all blood pressure medicine as recommended

RESOURCES:

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Hypertension Canada
http://www.hypertension.ca/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp

References:

Varounis C, Katsi V, Nihoyannopoulos P, Lekakis J, Tousoulis D. Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature. Front Cardiovasc Med. 2016;3:51.
Hypertensive crisis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114059/Hypertensive-crisis. Updated March 5, 2018. Accessed October 2, 2018.
Arbe G, Pastor I, Franco J. Diagnostic and therapeutic approach to the hypertensive crisis. Med Clin (Barc). 2018 Apr 23;150(8):317-22.
Suneja M, Sanders ML. Hypertensive Emergency. Med Clin North Am. 2017 May;101(3):465-78.
Last reviewed September 2018 by EBSCO Medical Review Board James P. Cornell, MD
Last Updated: 10/2/2018

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