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Malignant hypertension

Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignant

Malignant hypertension is very high blood pressure that comes on suddenly and quickly.

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Hypertensive kidney

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Causes

The disorder affects a small number of people with high blood pressure, including children and adults. It is more common in younger adults, especially African American men.

It also occurs in people with:

You are at high risk for malignant hypertension if you smoke and if you have had:

Symptoms

Symptoms of malignant hypertension include:

Exams and Tests

Malignant hypertension is a medical emergency.

A physical exam commonly shows:

An eye exam will reveal changes that indicate high blood pressure, including:

Tests to determine damage to the kidneys may include:

A chest x-ray may show congestion in the lungs and an enlarged heart.

This disease may also affect the results of these tests:

Treatment

You will need to stay in the hospital until your severe high blood pressure is under control. You will receive medicines through a vein (IV) to reduce your blood pressure.

If there is fluid in your lungs, you will be given medicines called diuretics, which help the body remove fluid. Your doctor may give you medicines to protect your heart if you have signs of heart damage.

After your severe high blood pressure is under control, blood pressure medicines taken by mouth can control blood pressure. Your medicine may need to be changed sometimes. High blood pressure can be difficult to control.

Outlook (Prognosis)

Many body systems are at serious risk from the extreme rise in blood pressure. Organs including the brain, eyes, blood vessels, heart, and kidneys may be damaged.

The blood vessels of the kidney are very likely to be damaged by high blood pressure. Kidney failure may develop, which may be permanent. If this happens, you may need dialysis (machine that removes waste products from blood).

If treated right away, malignant hypertension can often be controlled without causing permanent problems. If it is not treated right away, it can be fatal.

Possible Complications

These complications may occur:

When to Contact a Medical Professional

Go to the emergency room or call your local emergency number (such as 911) if you have symptoms of malignant hypertension. This is an emergency condition that can be life threatening.

Call your health care provider if you know you have poorly controlled high blood pressure.

Prevention

If you have high blood pressure, carefully monitor your blood pressure and take your medicines properly to help reduce your risk. Eat a healthy diet that is low in salt and fat.

Related Information

Preeclampsia
Renovascular hypertension
Acute kidney failure
Stroke
Seizures
Decreased alertness
Heart attack
Angina
Pulmonary edema

References

Bansal S, Linas SL. Hypertensive crisis: emergency and urgency. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 87.

Greco BA, Umanath K. Renovascular hypertension and ischemic nephropathy. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 41.

Kaynar AM. Arterial blood gas interpretation. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 36.

Levy PD, Brody A. Hypertension. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 74.

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Review Date: 4/15/2019  

Reviewed By: Walead Latif, MD, nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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