Malignant hypertension
Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignantMalignant hypertension is very high blood pressure that comes on suddenly and quickly.
High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
Read Article Now Book Mark ArticleCauses
The disorder affects a small number of people with high blood pressure, including children and adults. It is more common in younger adults, especially African American men.
It also occurs in people with:
- Collagen vascular disorders (such as systemic lupus erythematosus, systemic sclerosis, and periarteritis nodosa)
Collagen vascular disorders
In a class of diseases known as autoimmune disorders, the body's immune system attacks its own tissues. Some of these diseases are similar to each o...
Read Article Now Book Mark Article - Kidney problems
- Pregnancy-induced high blood pressure (toxemia of pregnancy also called preeclampsia)
Toxemia
Preeclampsia is high blood pressure and signs of liver or kidney damage that occur in women after the 20th week of pregnancy. While it is rare, pree...
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You are at high risk for malignant hypertension if you smoke and if you have had:
- Kidney failure
- Renal hypertension caused by renal artery stenosis
Renal hypertension
Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called ren...
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Symptoms
Symptoms of malignant hypertension include:
- Blurred vision
Blurred vision
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Change in mental status, such as anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, or stupor
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark ArticleConfusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark ArticleDecreased alertness
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
Read Article Now Book Mark ArticleFatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark ArticleRestlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
Read Article Now Book Mark ArticleSleepiness
Drowsiness refers to feeling more sleepy than normal during the day. People who are drowsy may fall asleep when they do not want to or at times whic...
Read Article Now Book Mark ArticleStupor
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
Read Article Now Book Mark Article - Chest pain (feeling of crushing or pressure)
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Read Article Now Book Mark Article - Cough
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
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Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Nausea or vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
Read Article Now Book Mark Article - Numbness of the arms, legs, face, or other areas
Numbness
Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...
Read Article Now Book Mark Article - Reduced urine output
Reduced urine
Decreased urine output means that you produce less urine than normal. Most adults make at least 500 milliliters of urine in 24 hours (a little over ...
Read Article Now Book Mark Article - Seizure
Seizure
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Weakness of the arms, legs, face, or other areas
Exams and Tests
Malignant hypertension is a medical emergency.
A physical exam commonly shows:
- Extremely high blood pressure
- Swelling in the lower legs and feet
- Abnormal heart sounds and fluid in the lungs
- Changes in thinking, sensation, and reflexes
An eye exam may reveal changes that indicate very high blood pressure, including:
- Bleeding of the retina (back part of the eye)
- Narrowing of the blood vessels in the retina
- Swelling of the optic nerve
- Other problems with the retina
Retina
The retina is the light-sensitive layer of tissue at the back of the eyeball. Images that come through the eye's lens are focused on the retina. Th...
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Tests to determine damage to the kidneys may include:
- Arterial blood gas analysis
Arterial blood gas analysis
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - BUN (blood urea nitrogen)
BUN
BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...
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Creatinine
The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine in t...
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Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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A chest x-ray may show congestion in the lungs and an enlarged heart.
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
Read Article Now Book Mark ArticleThis disease may also affect the results of these tests:
- Level of aldosterone (a hormone from the adrenal gland)
Aldosterone
The aldosterone blood test measures the level of the hormone aldosterone in blood. Aldosterone can also be measured using a urine test.
Read Article Now Book Mark Article - Cardiac enzymes (markers of heart damage)
- CT scan of the brain
CT scan of the brain
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark Article - Electrocardiogram (ECG)
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark Article - Renin level
- Urinary sediment
Treatment
You will need to stay in the hospital until your severe high blood pressure is under control. You will receive medicines through a vein (IV) to reduce your blood pressure.
If there is fluid in your lungs, you will be given medicines called diuretics, which help the body remove fluid. Your doctor may give you medicines to protect your heart if you have signs of heart damage.
After your severe high blood pressure is under control, blood pressure medicines taken by mouth can control blood pressure. Your medicine may need to be changed sometimes. High blood pressure can be difficult to control.
Outlook (Prognosis)
Many body systems are at serious risk from the extreme rise in blood pressure. Organs including the brain, eyes, blood vessels, heart, and kidneys may be damaged.
The blood vessels of the kidney are very likely to be damaged by high blood pressure. Kidney failure may develop, which may be permanent. If this happens, you may need dialysis (machine that removes waste products from blood).
Dialysis
Dialysis treats end-stage kidney failure. It removes harmful substances from the blood when the kidneys cannot. This article focuses on peritoneal d...
Read Article Now Book Mark ArticleIf treated right away, malignant hypertension can often be controlled without causing permanent problems. If it is not treated right away, it can be fatal.
Possible Complications
These complications may occur:
- Brain damage (stroke, seizures)
- Heart damage, including: heart attack, angina (chest pain due to narrowed blood vessels or weakened heart muscle), heart rhythm disturbances
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
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Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). T...
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- Permanent blindness
- Fluid in the lungs
Fluid in the lungs
Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of breath.
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When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of malignant hypertension. This is an emergency condition that can be life threatening.
Contact your health care provider if you know you have poorly controlled high blood pressure.
Prevention
If you have high blood pressure, carefully monitor your blood pressure and take your medicines properly to help reduce your risk. Eat a healthy diet that is low in salt and fat.
References
Elliott WJ, Peixoto AJ, Bakris GL. Primary and secondary hypertension. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46.
Greco BA, Umanath K. Renovascular hypertension and ischemic nephropathy. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 41.
Levy PD, Brody A. Hypertension. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 70.
Hypertensive kidney - illustration
The kidneys filter wastes and excrete fluid when the pressure of blood in the bloodstream forces blood through the internal structures of the kidney.
Hypertensive kidney
illustration
Review Date: 4/12/2023
Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.