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(Hypertensive Emergency; Hypertensive Crisis; Hypertensive Urgency)
by Alice A. McCarthy, MBA
Malignant hypertension is blood pressure that is so high that it is actually causing damage to organs, particularly in the nervous system, the cardiovascular system, and/or the kidneys. One type of such damage is called papilledema, a condition in which the optic nerve leading to the eye becomes dangerously swollen, threatening vision.
This is a serious condition that requires immediate care. Rapid treatment can prevent long-term problems. Left untreated, damage from malignant hypertension occurs quickly and can be severe, involving organ damage to blood vessels, the eyes, heart, spleen, kidneys, and brain. In particular, kidney failure may develop since the blood vessels inside the kidneys are very sensitive to high blood pressure.
In addition to having high blood pressure, medical conditions leading to the development of malignant hypertension include:
Risk Factors TOP
Malignant hypertension is more common in men, African Americans, and in smokers. You are more likely to develop malignant hypertension if you already have essential hypertension—high blood pressure of 140/90 or higher.
Malignant hypertension produces noticeable symptoms, including:
In particular, malignant hypertension can lead to a condition called hypertensive encephalopathy. Symptoms of this condition include headache, vomiting, blurry vision with papilledema, mental changes like anxiety, confusion, fatigue, and seizure.
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your blood pressure readings will probably be very high. Readings will be taken in both arms, while lying down and while standing up. A careful stethoscope exam of your heart and a detailed neurological exam will be performed. An eye exam may show signs of high blood pressure, including swelling of the optic nerve or bleeding inside the eye.
Tests may include the following:
Since malignant hypertension is a medical emergency, treatment needs to be received quickly. Treatment options include the following:
To help reduce your chance of developing malignant hypertension:
American Heart Association
National Heart, Lung, and Blood Institute
The Society of Obstetricians and Gynaecologists of Canada
Elliot WJ. Clinical features and management of selective hypertensive emergencies. J Clin Hypertens. 2004;6(10):587-92.
Hypertensive crisis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114059/Hypertensive-crisis. Updated July 18, 2017. Accessed September 1, 2017.
Tuncel M, Ram VC. Hypertensive emergencies: etiology and management. Am J Cardiovasc Drugs. 2003;3(1):21-31.
Van den Born BJ, Honnebier UP, Koppmans RP, van Montfrans GA. Microangiopathic hemolysis and renal failure in malignant hypertension. Hypertension. February 2005;45(2):246-51.
Last reviewed September 2017 by EBSCO Medical Review Board James P. Cornell, MD
Last Updated: 9/30/2013
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