Malignant Hypertension

What is malignant hypertension?

This condition occurs when there is a sudden rise in blood pressure. It typically happens in people who already have high blood pressure (hypertension). But other medical conditions, like a kidney injury or an endocrine disorder, can cause it as well.

Are there different types of malignant hypertension?

Malignant hypertension is also known as a hypertensive crisis. There are two types:

• Hypertensive emergency is when a rise in blood pressure occurs with signs of organ damage. This is a medical emergency that requires immediate care.
• Hypertensive urgency occurs when blood pressure is abnormally high, but there are no signs of organ damage.

Is there a specific blood pressure reading that’s used to diagnose malignant hypertension?

No. These conditions can happen in people who don't have high blood pressure. Healthcare providers make the diagnosis based on a significant increase from your normal blood pressure.

What causes malignant hypertension?

Uncontrolled high blood pressure is one of the main causes of malignant hypertension.

Other causes include:

• Adrenal disorders including Conn’s syndrome, Cushing’s syndrome, pheochromocytoma or a renin-secreting tumor.
• Central nervous system disorders like a brain bleed, stroke or traumatic brain injury.
• Drugs and medications.
• Renal artery disease (affecting the arteries that supply the kidneys).
• Structural heart disease.
• Thyroid disorders.
• Substance and medication withdrawal.

What are malignant hypertension symptoms?

Symptoms depend on which organs are affected. You may experience:

• Chest pain.
• Decreased urine output.
• Delirium.
• Headaches.
• Lower back pain.
• Mood changes.
• Nausea and vomiting.
• Shortness of breath (dyspnea).
• Vision changes, including blurred vision.

How is malignant hypertension diagnosed?

Healthcare providers perform a comprehensive assessment to determine whether there is hypertensive urgency or an emergency.

The types of tests you have depends on your symptoms and may include:

• Chest X-ray, which helps detect signs of fluid retention in the lungs (pulmonary edema).
• Electrocardiogram (EKG) to check for arrhythmia.
• Eye exam to detect signs of hemorrhage or eye damage.
• Neurologic exam to test brain functioning.
• Physical exam, including blood pressure readings in both arms.
• Toxicology study to identify types of drugs in your system.
• Urinalysis to screen for liver and kidney issues.

What does treatment for a hypertensive emergency look like?

This form of malignant hypertension requires care that starts in an emergency room. Therapy includes special medications to lower your blood pressure. You receive these drugs through a vein (intravenously).

This phase of treatment may last up to two days. You’ll need to stay in the hospital until your blood pressure reaches a safe range. Once your blood pressure is under control, you continue taking blood pressure medications by mouth.

How is hypertensive urgency treated?

Hypertensive urgency does not need inpatient care or intravenous blood pressure medications. Instead, you take blood pressure medications by mouth. These drugs gradually decrease blood pressure until it reaches a safe range.

If hypertensive urgency does not cause organ damage, why is it important to treat it?

People with hypertensive urgency have one or more risk factors that increase the likelihood of future organ damage.

These include:

• Diabetes.
• History of heart disease.
• Obesity.
• Tobacco use.
• Uncontrolled high blood pressure.

Will I need additional treatments once my blood pressure reaches a safe range?

Both types of malignant hypertension need close monitoring from your healthcare provider. Within a few days, you’ll need a follow-up appointment. This visit is an opportunity to make sure your blood pressure remains in control. Your healthcare provider may adjust medications to keep your care on the right track.

Can hypertensive emergencies be prevented?

There are steps you can take to prevent malignant hypertension, including:

• Taking blood pressure medications if your doctor prescribes them.
• Talking to your healthcare provider if you are experiencing challenges with daily medications.
• Following through on routine physical exams and specialist visits.
• Keeping other medical conditions, such as diabetes, under control.

What is the outlook for people with malignant hypertension?

The short-term outlook is generally good for people who receive timely care. Emergency treatments are often successful. But you may still be at risk for complications. Researchers are exploring the long-term health consequences of malignant hypertension.

What are the potential complications of malignant hypertension?

Sudden spikes in blood pressure can cause many severe health issues, including:

• Aortic dissection.
• Acute heart failure.
• Acute kidney injury.
• Brain damage.
• Heart attack.
• Hemorrhage.
• Stroke.
• Unstable angina.
• Vision loss.

Can malignant hypertension come back?

Even with successful treatment, it’s possible to experience another hypertensive emergency. You can lower your risk by living a healthy lifestyle, including:

• Maintaining a healthy weight.
• Finding healthy ways to manage stress.
• Quitting smoking and using tobacco products.
• Eating a balanced diet that’s low in sodium and saturated fats.

A note from Cleveland Clinic

Malignant hypertension happens when there’s a sudden rise in blood pressure. In some people, it occurs with signs of organ damage. Other people do not experience organ damage but face a high risk of experiencing it. Treatment includes medications to bring your blood pressure back to a safe range. After treatment, it’s important to follow up with your healthcare provider and take good care of yourself. Doing so can help you avoid future episodes or delayed organ damage.