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Malignant Hypertension

(Hypertensive Emergency; Hypertensive Crisis; Hypertensive Urgency)

Definition

Malignant hypertension is blood pressure that is so high that it can harm the body. It can be deadly and needs to be treated right away.
Cardiovascular System and Kidneys
Placement of Blood Pressure Cuff
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Causes

This problem can happen when high blood pressure is not managed with medicine. Some other problems that may lead to it are:
  • Kidney disorders or failure
  • Taking some medicines, such as monoamine oxidase inhibitors or birth control pills
  • Using drugs, such as cocaine or amphetamines
  • Being pregnant and having preeclampsia or eclampsia
  • Hormonal problems, such as Cushing disease
  • Spinal cord problems
  • Coarctation of the aorta
  • Narrowing of the arteries to the kidneys

Risk Factors

This problem is more common in older adults, especially men. It is also more common in people who are Black. Other things that may raise the risk are:
  • Heart failure
  • Marijuana use
  • Coronary artery disease
  • Kidney disease
  • High cholesterol

Symptoms

Some people may not have symptoms. Others may have:
  • Headache
  • Nausea and vomiting
  • Eyesight problems
  • Numbness of the legs, arms, or face
  • Problems breathing
  • Chest pain

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. Blood pressure readings will be taken.
These tests may be done to look for damage in the body:
  • Blood and urine tests
  • An electrocardiogram (ECG) to measure the electrical activity in the heart
  • An eye exam to look for swelling or bleeding
  • Images of the body taken with:

Treatment

This problem needs to be treated right away. Options depend on the damage that has happened.
Medicine will be given to lower blood pressure. It may be given by IV. This lets the medicine quickly lower blood pressure. Options are:
  • Sodium nitroprusside or nitroglycerin
  • Beta-blockers
  • Other vasodilators
  • angiotensin-converting enzyme (ACE)-inhibitor
A care plan will be made to keep blood pressure at a healthy level. Medicine will need to be part of it.

Prevention

People with high blood pressure can lower the chance of this problem by checking their blood pressure often and taking medicine to lower it.

RESOURCES

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Hypertension Canada
http://www.hypertension.ca
Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

References

Arbe G, Pastor I, et al. Diagnostic and therapeutic approach to the hypertensive crisis. Med Clin (Barc). 2018 Apr 23;150(8):317-22.
Hypertensive crisis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hypertensive-crisis. Updated April 17, 2019. Accessed December 3, 2019.
Suneja M, Sanders ML. Hypertensive Emergency. Med Clin North Am. 2017 May;101(3):465-78.
Varounis C, Katsi V, et al. Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature. Front Cardiovasc Med. 2016;3:51.
Williams B, Mancia G, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33);3021-3104.

Revision Information

  • Reviewer: EBSCO Medical Review Board James P. Cornell, MD
  • Review Date: 09/2019
  • Update Date: 08/04/2020
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