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.
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 have had:
Symptoms of malignant hypertension include:
Malignant hypertension is a medical emergency.
A physical exam commonly shows:
An eye examination will reveal changes that indicate high blood pressure, including:
Kidney failure, as well as other complications, may develop.
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:
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.
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, complications may be severe and life-threatening.
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.
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.
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Shayne P, Lynch CA. Hypertensive crisis. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 69.
Shayne P, Stettner E. Hypertension. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 89.
Last reviewed on: 5/19/2015
Reviewed by: Charles Silberberg, DO, private practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.