Malignant Hypertension: Causes, Symptoms, and Treatment

Malignant hypertension is a rare but serious form of hypertension, or high blood pressure, which needs to be treated quickly. It is defined as the systolic (the top number) and diastolic (the bottom number) numbers being higher than 240 and 120. If this condition is treated on a prompt basis, it can cause complications in the eyes, brain, lung, and/or kidneys.

Eyes- If hypertension is left untreated, it can affect the eyes in that there will be flame-shaped hemorrhages in the retina, or there will be small, soft exudates. This is called hypertensive retinopathy. Malignant hypertension differs from hypertensive retinopathy in that there is papilledema, or swelling around the optic nerve.

Brain- While headaches are uncommon in hypertension; it is very common in malignant hypertension if the blood pressure is extremely high. Brain involvement with malignant hypertension can sometimes cause convulsions.

Lungs- Malignant hypertension can cause congestion in the lungs and results from fluid being forced into the lungs from heart failure as a result from the blood pressure being too high.

Kidneys- Malignant hypertension can also cause kidney or renal failure by obstruction of the arteries, causing less blood to flow to the kidneys.

Symptoms from malignant hypertension include blurry vision, vomiting, chest pains or a crushing sensation on the chest, decreased urine output, and/or tingling or numbness in the face, neck, arms, hands, or feet.

Like hypertension overall, the exact cause of malignant hypertension is uncertain. While little is still known about this condition, there are a few things that are known. Younger people are more likely to get malignant hypertension than older people which is the opposite of general hypertension. Those of African descent are more likely to get malignant hypertension, as well as those who already have a history of kidney failure and pregnant women that have gestational hypertension.

There are two hypertensive conditions that are still of some concern such as hypertensive urgency and hypertensive emergency. With hypertensive urgency, the blood pressure will be high with no serious symptoms. This means that people could be at risk for developing malignant hypertension if left untreated. In hypertensive emergency there can be organ damage and bringing the blood pressure down is crucial. The systolic number in hypertensive emergency will usually be greater than 220.

People with malignant hypertension need to treated quickly and should always be admitted into the hospital for close observation. In some cases, people may be admitted into the ICU (Intensive Care Unit). With hospital stays, intravenous drugs are the main focus of therapy because they work in the body quicker than medicines taken orally. Two drugs that are commonly used to bring high blood pressure down are nitroglycerin and nitroprusside. Several blood tests will be done several times a day to evaluate the organs. If treated promptly, malignant hypertension has a good outlook. After the hospital stay, it is common and recommended that people be prescribed medicines such as beta blockers or ACE inhibitors to avoid malignant hypertension in the future.