The Dangers of Malignant Hypertension

When High Blood Pressure Turns Deadly

Doctor checks man's blood pressure.
Katrina Wittkamp / Getty Images

Malignant hypertension is a serious form of high blood pressure that causes damage to one or more organ systems. While rare—affecting only around one percent of people with a history of high blood pressure—malignant hypertension can cause irreversible damage and even death if not treated immediately.

Malignant hypertension is defined as a blood pressure reading over 180/120. By contrast, a normal blood pressure is anything below 140/90.

While all major organ systems are at risk of injury in a malignant hypertensive event, the kidneys, eyes, brain, and heart are the most prone to damage. Malignant hypertension develops rapidly, causing the rupture of smaller blood vessels throughout the body.

Causes of Malignant Hypertension

The causes of malignant hypertension are not well understood. In many cases, it appears to be the result of multiple contributing factors. Among them:

While a history of high blood pressure is considered central to the risk, other, entirely unrelated factors can trigger a malignant hypertensive episode. These include the use of illegal drugs (such as cocaine or methamphetamine), birth control pills, head trauma, and spinal cord injuries.

Some of these factors may account for why younger people are more prone to malignant hypertension than older adults. By contrast, older adults are more likely to be on anti-hypertensive drugs thereby reducing their risk.

Symptoms of Malignant Hypertension

Because malignant hypertension affects the organs most sensitive to blood pressure changes, the symptoms are largely dependant on the location of the vascular injury.

Some of the more common signs include:

  • Blurry vision
  • Headache
  • Chest pain 
  • Irregular heartbeat
  • Nosebleed
  • Shortness of breath
  • Tingling, numbness, burning, or prickly skin sensations
  • Faintness or dizziness
  • Reduced urine output
  • Nausea or vomiting
  • Altered mental state
  • Burst retinal capillaries
  • Seizures

While these symptoms are not exclusive to malignant hypertension, they are associated with a number of potentially serious conditions like heart attack, stroke, or kidney failure. For this reason alone, symptoms like these should never be ignored.

Treating Malignant Hypertension

The diagnosis of malignant hypertension is made by taking the person’s blood pressure. Those diagnosed should be immediately admitted to the hospital for close observation and treatment. Depending on how serious the event is, admission to intensive care may be needed.

Intravenous drugs will be used to gradually reduce the blood pressure, including sodium nitroprusside and nitroglycerin. Kidney, brain, and heart function may also be closely monitored to assess any irregularities that require emergency intervention. In extreme cases, bloodletting may be used if the intravenous drugs are not working fast enough.

Once stabilized, imaging tests may be ordered to check for any significant bleeding or injury.

These may include ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Once the person is stabilized enough to be released, anti-hypertensive drugs such as beta blockers or ACE inhibitors may be prescribed if they haven’t already been.

Sources:

Cremer, A.; Amraoui, F.; Lip, G. et al. "From malignant hypertension to hypertension-MOD: a modern definition of an old but still dangerous emergency." Journal of Human Hypertension. 2016; 30:463-466.

Kessler, C. and Joudeh, Y. "Evaluation and Treatment of Severe Asymptomatic Hypertension."American Family Physician. 2010; 81(4):470-476.

Continue Reading