Overview, Causes, & Risk Factors
Malignant hypertension refers to extremely
high blood pressure that can cause injury to the eyes, heart, brain, and
kidneys. This can result in permanent damage to these organs and even death.
What is going on in the body?
Uncontrolled severe hypertension, or high
blood pressure, causes injury to the blood vessels within the kidney,
brain, heart, and eyes.
What are the causes and risks of the disease?
Many individuals have diagnosed high blood
pressure. If it is left untreated, the high blood pressure can lead to
malignant hypertension in a small percentage of these people. Malignant
hypertension is very rare in a person with no history of high blood pressure.
Symptoms & Signs
What are the signs and symptoms of the disease?
Symptoms of malignant hypertension include:
vision changes, such as blurry
fatigue and weakness
nausea and vomiting
Diagnosis & Tests
How is the disease diagnosed?
Malignant hypertension is diagnosed by a physical examination. An eye exam will show changes that signal
very high blood pressure. A healthcare provider will also take a person's blood
pressure. When blood pressure is measured, there are two numbers that are
reported, for example, 140/90. The top number is the systolic blood pressure,
and the bottom number is the diastolic blood pressure. An example of extremely
high blood pressure is 220/140.
Other signs that a person has malignant hypertension include:
diastolic blood pressure that is always more than 120
signs of congestive heart failure
and chronic renal failure
changes in mental status, such as
confusion and memory loss
These signs indicate a medical emergency. Blood pressure must be controlled quickly
to avoid permanent damage to internal organs and death.
Prevention & Expectations
What can be done to prevent the disease?
Maintaining a healthy body weight, including physical activity in everyday
life, and eating a diet designed to
minimize heart disease can help avoid high blood pressure. However, even with
these lifestyle guidelines, many cases of high blood pressure cannot be
prevented. If there is a medical cause of high blood pressure, treatment of
that condition can help prevent hypertension.
What are the long-term effects of the disease?
There are many serious long-term effects of malignant hypertension, including:
damage to the brain, kidneys, and heart
blood vessel damage to the eye, with loss of vision
atherosclerosis, or narrowing of
chronic renal failure, a form
kidney failure that requires dialysis
filter body fluids
enlargement of the heart, which weakens the heart muscle and leads to congestive heart failure
heartbeats, or arrhythmias
What are the risks to others?
Malignant hypertension is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the disease?
If the malignant hypertension is caused by another condition, treating the underlying
condition may lower blood pressure. There are many medications used to
treat high blood pressure, including:
diuretics, such as
beta-blockers, such as propranolol
angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril
angiotensin II receptor blockers, such as losartan or valsartan
vasodilators, such as hydralazine
centrally acting nervous system medications, such as
Calcium channel blockers, such as
diltiazem, nifedipine, or
verapamil, have been used for over 20
years to treat high blood pressure. However, the findings of 2 recent studies show
that people who take a calcium channel blocker have a much higher incidence of
complications than people taking other medications for high blood pressure.
The findings of one study, for example, showed that the risk of heart attack was 27% greater, and the risk of congestive heart failure was 26% higher. The American
Heart Association recommends discussing the risks and benefits of the
medication with a healthcare provider.
The choice of medication varies depending on the person's medical history. Beta-
blockers usually are not prescribed for someone who has breathing problems such as asthma or emphysema. ACE
inhibitors and diuretics to reduce fluid buildup are especially useful for an individual with kidney disease or
diabetes. A person with high blood pressure may be on multiple
The goal of treatment is to keep the top number of the blood pressure below 140 and the bottom number
below 90. In a person with diabetes, the goal is to keep the top number below
130 and the bottom number below 85. For an individual with heart disease or
disease, the goal is to get the blood pressure as low as can be
What are the side effects of the treatments?
Side effects vary according to the medications used. Beta- blockers can worsen
asthma. Diuretics can cause dehydration and salt imbalance. Calcium channel blockers can cause swelling of
legs, as well as a
higher risk of heart attack and
congestive heart failure. ACE inhibitors
lead to chronic dry cough.
What happens after treatment for the disease?
A person who has malignant hypertension needs to continue taking the prescribed medications every day. Blood pressure may return to normal with weight loss, increased physical
reduction of alcohol intake, and a
diet low in sodium. In most cases
person will need to continue to take blood pressure medications for life.
How is the disease monitored?
Malignant hypertension is monitored through frequent visits to a healthcare
professional. A person with high blood pressure often records blood pressure readings in between
visits. Any new or worsening symptoms should be reported to the healthcare