Malignant high blood pressure (malignant hypertension) is very high blood pressure that comes on suddenly and is an emergency. If not treated, it can damage the brain, heart, eyes, or kidneys.
Symptoms include numbness, blurry vision, chest pain, severe headache, and confusion.
This problem is also called hypertensive crisis or hypertensive emergency.
Quick-acting medicines are used to lower blood pressure.
The cause may be unknown. Or the problem may be caused by medicine or another condition.
Call your doctor now or seek immediate care if:
Malignant high blood pressure can cause:
It is better to prevent episodes of malignant high blood
pressure than to treat an episode after you have already had one. One of the
most common causes of malignant high blood pressure is not taking your blood
pressure medicines properly. Sometimes this happens unintentionally. For
example, your prescription may run out or you may forget to take a dose. But
try to stay on your medicine schedule as best as you can. Another cause of
malignant blood pressure is illegal drug use, such as stimulants like cocaine.
To treat malignant high blood pressure,
doctors and nurses will carefully monitor your blood pressure and give you
medicine intravenously (through a needle inserted in one of your veins). The
immediate goal is to lower your blood pressure enough so that your organs are
no longer in immediate danger. But it must be lowered slowly so that your body
has enough time to adjust to the change in blood pressure. If blood pressure is
lowered too quickly, your body may have a hard time getting blood to your
The other goal of treatment is to treat organ
complications. For example, your doctor may give you a diuretic if you have
fluid buildup in your lungs. Or your doctor may give a beta-blocker and
nitrates if you have myocardial ischemia (not enough blood is reaching your
heart). After your doctor has lowered your blood pressure to a safe level and
treated your complications, he or she will try to identify the cause of the
acute episode. Your doctor will then work with you to create a treatment
regimen that can help prevent future attacks.
Other Works Consulted
Atkins GB, et al. (2011). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1585–1605. New York: McGraw-Hill.
April 5, 2013
E. Gregory Thompson, MD - Internal Medicine
& Robert A. Kloner, MD, PhD - Cardiology
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