Malignant High Blood Pressure
From WebMD.com
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Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. "Normal" blood pressure is below 140/90. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency.
What Causes Malignant Hypertension? In many people, high blood pressure is the main cause of malignant hypertension. Missing doses of blood pressure medications can also cause it. In addition, there are certain medical conditions that can cause it. They include:
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Who's at Risk for Malignant Hypertension?
Malignant hypertension is rare. About 1% of people who have a history of high blood pressure develop this life-threatening condition.
You are at greater risk of developing it if you are a man, African-American, or someone of lower economic status. Poor access to health care increases the risk.
What Are the Symptoms of Malignant Hypertension?
The main symptoms of malignant hypertension are a rapidly increasing blood pressure of 180/120 or higher and signs of organ damage. Usually, the damage happens to the kidneys or the eyes.
Other symptoms depend on how the rise in blood pressure affects your organs. A common symptom is bleeding and swelling in the tiny blood vessels in the retina. The retina is the layer of nerves that line the back of the eye. It senses light and sends signals to the brain through the optic nerve, which can also be affected by malignant hypertension. When the eye is involved, malignant hypertension can cause changes in vision.
Other symptoms of malignant hypertension include:
Symptoms include:
Malignant hypertension is rare. About 1% of people who have a history of high blood pressure develop this life-threatening condition.
You are at greater risk of developing it if you are a man, African-American, or someone of lower economic status. Poor access to health care increases the risk.
What Are the Symptoms of Malignant Hypertension?
The main symptoms of malignant hypertension are a rapidly increasing blood pressure of 180/120 or higher and signs of organ damage. Usually, the damage happens to the kidneys or the eyes.
Other symptoms depend on how the rise in blood pressure affects your organs. A common symptom is bleeding and swelling in the tiny blood vessels in the retina. The retina is the layer of nerves that line the back of the eye. It senses light and sends signals to the brain through the optic nerve, which can also be affected by malignant hypertension. When the eye is involved, malignant hypertension can cause changes in vision.
Other symptoms of malignant hypertension include:
- Blurred vision
- Chest pain (angina)
- Difficulty breathing
- Dizziness
- Numbness in the arms, legs, and face
- Severe headache
- Shortness of breath
Symptoms include:
- Blindness
- Changes in mental status
- Coma
- Confusion
- Drowsiness
- Headache that continues to get worse
- Nausea and vomiting
- Seizures
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High blood pressure, in general, makes it difficult for kidneys to filter wastes and toxins from the blood. It is a leading cause of kidney failure. Malignant hypertension can cause your kidneys to suddenly stop working properly.
How Is Malignant Hypertension Diagnosed? A diagnosis of malignant hypertension is based on blood pressure readings and signs of acute organ damage. If you have symptoms of malignant hypertension, the doctor will:
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- Order blood and urine tests that may include:
- Blood urea nitrogen (BUN) and creatinine levels, which increase if you have kidney damage
- Blood clotting tests
- Blood sugar (glucose) level
- Complete blood count
- Sodium and potassium levels
- Urinalysis to check for blood, protein, or abnormal hormone levels related to kidney problems
The doctor will also ask for imaging tests, including:
- Echocardiogram to check heart function and blood flow through the heart
- Electrocardiogram (ECG) to check the heart’s electrical function
- Chest X-ray to look at the shape and size of the heart structures and to detect fluid in the lungs
- Other imaging tests to evaluate the kidneys and their arteries
How Is Malignant Hypertension Treated?
Malignant hypertension is a medical emergency and needs to be treated in a hospital, often in an intensive care unit. The doctor will consider your symptoms and overall health when deciding what treatment plan is best for you. The goal of treatment is to carefully lower your blood pressure within a matter of minutes.
You will receive blood pressure medicines through an IV, which is the quickest way to treat extremely high blood pressure. Once blood pressure is at a safe level, the medications may be switched to oral forms. If you develop kidney failure, you may need kidney dialysis.
Other treatments depend on your specific symptoms and possible causes of the malignant hypertension.
What Are Complications of Malignant Hypertension?
Untreated, malignant hypertension causes death. Complications of malignant hypertension also may include:
- Aortic dissection, which is a sudden rupture of the main blood vessel leaving the heart
- Coma
- Fluid in the lungs, called pulmonary edema
- Heart attack
- Heart failure
- Stroke
- Sudden kidney failure
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Resistant hypertension: From Mayo Clinical Staff When your blood pressure is difficult to control If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure generally should be reconsidered. |
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Adding an aldosterone antagonist such as spironolactone (Aldactone) often leads to control of resistant hypertension. Some experimental therapies such as catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are being studied.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Adding an aldosterone antagonist such as spironolactone (Aldactone) often leads to control of resistant hypertension. Some experimental therapies such as catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are being studied.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.