What is Malignant Hypertension?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 29 September 2019
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Malignant hypertension is a medical emergency characterized by a sudden and very fast rise in blood pressure. If it is not treated, the patient can develop a coma and may eventually die, and even with treatment, patients with malignant hypertension are at risk of organ damage. Treatment for this condition is usually provided in a hospital setting until the patient's blood pressure is stabilized, at which point the patient can be discharged to begin outpatient treatment, which usually includes monitoring of the blood pressure for signs of changes which could signal a return of dangerously high blood pressure.

Usually, the onset of malignant hypertension is related to an ongoing disease process, such as kidney disease. In other cases, there is no clear cause. People with malignant hypertension experience symptoms such as swelling in the legs and feet, nausea, vomiting, dizziness, confusion, and bleeding in the eyes caused by a dangerous rise in pressure in the blood vessels which supply the eye. Many also develop fluid around the heart and lungs.


The concern with malignant hypertension is that damage to the organs which can occur over years of systemic high blood pressure can happen in days or even hours. The patient's systolic blood pressure may be above 220, with the diastolic above 130, and this can cause a very rapid onset of damage to the organs, especially the eyes and kidneys. If the high blood pressure persists, the brain can also be injured, and permanent impairments may result.

The immediate treatment for malignant hypertension is medications to reduce the patient's blood pressure, with the goal of reaching a safer and more stable level. Once the patient is comfortable, diagnostic tests can be performed to find out why the patient's blood pressure skyrocketed, and to treat the underlying cause. For example, more aggressive treatment might be needed for kidney disease to address a decline in kidney function. This can involve a medical team to address multiple areas of concern when it comes to the patient's care.

The patient may also need to pursue ongoing hypertension treatment. This can include medications to keep blood pressure at a reasonably low level, along with ongoing monitoring, especially if the patient developed organ damage as a result of the malignant hypertension episode. Since this condition is often linked with kidney damage, the patient may need to work with a nephrologist who can assess kidney health and develop a monitoring and treatment plan with the patient.


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