Malignant hypertension is very
that comes on suddenly and quickly.
The disorder affects a small number of people with high blood pressure, including children and adults. It is more common in younger adults, especially African American men.
It also occurs in people with:
(such as systemic lupus erythematosus, systemic sclerosis, and periarteritis nodosa)
Kidney problems
Pregnancy-induced high blood pressure (
of pregnancy also called preeclampsia)
You are at high risk for malignant hypertension if you smoke and if you have had:
Kidney failure
caused by renal artery stenosis
Symptoms of malignant hypertension include:
Change in mental status, such as
,
,
, decreased ability to concentrate,
,
,
, or stupor
(feeling of crushing or pressure)
of the arms, legs, face, or other areas
output
of the arms, legs, face, or other areas
Malignant hypertension is a medical emergency.
A physical exam commonly shows:
Extremely high blood pressure
Swelling in the lower legs and feet
Abnormal heart sounds and fluid in the lungs
Changes in thinking, sensation, and reflexes
An eye exam may reveal changes that indicate very high blood pressure, including:
Bleeding of the retina (back part of the eye)
Narrowing of the blood vessels in the retina
Swelling of the optic nerve
Other problems with the
Tests to determine damage to the kidneys may include:
(blood urea nitrogen)
A
may show congestion in the lungs and an enlarged heart.
This disease may also affect the results of these tests:
Level of
(a hormone from the adrenal gland)
Cardiac enzymes (markers of heart damage)
(ECG)
Plasma
level
Urinary sediment
You will need to stay in the hospital until your severe high blood pressure is under control. You will receive medicines through a vein (IV) to reduce your blood pressure.
If there is fluid in your lungs, you will be given medicines called diuretics, which help the body remove fluid. Your health care provider may give you medicines to protect your heart if you have signs of heart damage.
After your severe high blood pressure is under control, blood pressure medicines taken by mouth can control blood pressure. Your medicine may need to be changed over time. High blood pressure can be difficult to control.
Many body systems are at serious risk from the extreme rise in blood pressure. Organs including the brain, eyes, blood vessels, heart, and kidneys may be damaged.
The blood vessels of the kidney are very likely to be damaged by high blood pressure. Kidney failure may develop, which may be permanent. If this happens, you may need
(a machine that removes waste products from blood).
If treated right away, malignant hypertension can often be controlled without causing permanent problems. If it is not treated right away, it can be fatal.
These complications may occur:
Brain damage (
, seizures)
Heart damage, including:
,
(chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances
Kidney failure
Permanent blindness
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of malignant hypertension. This is an emergency condition that can be life threatening.
Contact your provider if you know you have poorly controlled high blood pressure.
If you have high blood pressure, carefully monitor your blood pressure and take your medicines properly to help reduce your risk. Eat a healthy diet that is low in salt and fat.
Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignant
Elliott WJ, Peixoto AJ, Bakris GL. Primary and secondary hypertension. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46.
Greco BA, Papamarkakis KE. Renovascular hypertension, atherosclerotic renal vascular disease, and thromboembolic kidney disease. In: Johnson RJ, Floege J, Tonelli M, eds. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024:chap 43.
Levy PD, Brody A. Hypertension. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 70.
Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.