| Subject | Contents |
| Definition | Clinical syndrome of markedly high blood pressure with retinal hemorrhages and retinal exudates, and often including confusion, headaches, vomiting, and visual disturbances. |
| Alternative Names | Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant |
| Causes, incidence, and risk factors | Malignant hypertension is a medical emergency condition where there is a severe rise in the blood pressure . The cause is unknown, but there is often a prior history of hypertension , especially hypertension resulting from kidney disorders (secondary hypertension). The disorder affects about 1% of hypertension patients including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy , and people with renal or collagen vascular disorders . A history of acute renal failure or renal hypertension caused by renal artery stenosis indicates a high risk for malignant hypertension. There is a sudden, rapid increase in blood pressure, usually for no observable cause. The disorder can cause severe, permanent, life-threatening consequences from pressure damage to multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and acute renal failure may develop; this renal failure may be permanent. |
| Symptoms | blurred visionheadachechange in mental statusrestlessnessanxietydecreased alertness , decreased ability to concentrate fatiguesleepy , stuporous , lethargicconfused , delirious chest pain mid chest location most common crushing or pressure sensation shortness of breathcoughdecreased urinary outputnausea , vomitingseizureweakness of the arms, legs, face, or other areas abnormal sensation ( numbness ) of the arms, legs, face, or other areas |
| Signs and tests | Blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure , including papilledema ( swelling of the optic nerve), retinal bleeding, or infarction (cotton wool spots or soft exudate -- fluid with cellular debris) in the retina . If not already present, acute renal failure may develop as a complication of malignant hypertension. Other complications may also develop. Damage to the kidneys may be demonstrated by: a BUN increase a creatinine increasearterial blood gas analysis shows metabolic acidosisurinalysis shows high protein levels (especially with kidney impairment) or microscopic hematuria ( blood in the urine ) A chest X-ray may indicate pulmonary (lung) congestion from fluid forced into the lungs by heart failure as a consequence of the high blood pressure. This disease may also alter the results of the following tests:urinary castsreninaldosterone |
| Treatment | Hospitalization is essential until the severe blood pressure '>high blood pressure is under control. Intravenous medications such as nitroprusside, nitroglycerin, or others may reduce blood pressure . After the acute hypertension is brought under control, oral (by mouth) anti-hypertensive medications can maintain control of the blood pressure. The medication may need to be adjusted occasionally. Hypertension can be difficult to control. |
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| Expectations (prognosis) | If treated promptly, malignant hypertension is often controlled without permanent complications. If it is not treated promptly, complications may be severe and life-threatening. |
| Complications | recurrence of malignant hypertension episodes damage to the brain from: hypertensive encephalopathy spasm or constriction of the arteries of the brain cerebral edemastrokeseizuresintracerebral hemorrhagecoma pressure damage to the eyes, permanent blindness pressure damage to the heart decreased cardiac output heart attackanginapulmonary edemaacute renal failure |
| Calling your health care provider | Go to the emergency room or call the local emergency number (such as 911) if symptoms of malignant hypertension develop. This is an emergency condition! Call your health care provider if known hypertension is poorly controlled. |
| Prevention | Careful monitoring of blood pressure in people known to be hypertensive and close compliance with the medical treatment for hypertension help to reduce the risk. |
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