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Malignant Hypertension

(Hypertensive Emergency; Hypertensive Crisis; Hypertensive Urgency)

Definition

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.
Cardiovascular System and Kidneys
Placement of Blood Pressure Cuff
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Causes

In addition to having high blood pressure , medical conditions leading to the development of malignant hypertension include:

Risk Factors

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.

Symptoms

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.

Diagnosis

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:

Treatment

Since malignant hypertension is a medical emergency, treatment needs to be received quickly. Treatment options include the following:
  • IV high blood pressure medications–The specific medication will be chosen based on your specific situation, including whether you are suffering from damage to your kidneys or other organs. Possible medications may include:
    • Sodium nitroprusside or nitroglycerin
    • Beta-blockers
    • Hydralazine
    • Labetalol
    • Vasotec and ACE-inhibitor
  • Oral high blood pressure medicines once blood pressure has been lowered from dangerous levels
  • Dialysis

Prevention

To help reduce your chance of developing malignant hypertension:

RESOURCES

American Heart Association http://www.heart.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

The Canadian Hypertension Society http://www.hypertension.ca

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

References

Elliot WJ. Clinical features and management of selective hypertensive emergencies. J Clin Hypertens. 2004;6(10):587-92.

Hypertensive emergency. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 7, 2013. Accessed August 15, 2014.

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.

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