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:
Malignant hypertensive is more common in men, African Americans, and in smokers. You are more likely to develop malignant hypertension if you have 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.
If you experience any of the above symptoms, do not assume it is due to malignant hypertension. These symptoms may be caused by other health conditions, including a heart attack or other less serious disorders. If you experience any one of them, call for emergency medical services right away.
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:
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 15, 2015. Accessed September 29, 2016.
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 2016 by Michael J. Fucci, DO, FACC
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.