Malignant Hypertension: Causes, Symptoms, Treatment, Complications, Risk Factors, Diagnosis

Malignant hypertension is a condition where there is rapid development of extremely high blood pressure resulting in damage to the organs. Blood pressure which is below 140/90 mmHg is considered to be normal. In malignant hypertension, the patient has a blood pressure which is usually more than 180/120 mmHg. Malignant hypertension is a medical emergency and needs prompt medical attention.

High blood pressure is the primary cause of malignant hypertension in most of the patients. High blood pressure develops when the patient misses doses of his/her blood pressure medications or forgets to take blood pressure medications on time. Other than this, there are some medical conditions which can cause malignant hypertension and they are:

• Kidney disease.
• Collagen vascular diseases.
• Tumor of the adrenal gland.
• Injuries to the spinal cord.
• Use of illegal drugs.
• Use of certain medications, such as MAOIs and birth control pills.

Malignant hypertension is a rare development. Around 1% of patients with a history of high blood pressure will develop this fatal condition.

• Men are at increased risk for developing malignant hypertension than women.
• People from lower economic status are at increased risk for developing malignant hypertension.
• People of African-American ethnicity are at increased risk for developing malignant hypertension.
• Having poor access to health care also increases the risk for developing malignant hypertension.

Rapidly increasing blood pressure which is over than 180/120 mmHg is the main symptom of Malignant Hypertension. Other than this, symptoms will also consist of signs of organ damage. In most of the patients, the damage occurs in the eyes or kidneys.

Other symptoms of Malignant Hypertension depend on how the Malignant Hypertension affects the patient’s organs. A common symptom of this is swelling and bleeding in the tiny blood vessels of the retina. The retina is responsible for sensing the light and transmitting signals to the brain via optic nerve and all this gets affected by malignant hypertension. Malignant hypertension, if it involves the eye, can cause changes in vision.

Additional symptoms of malignant hypertension are: Chest pain (angina), dizziness, breathing difficulties, numbness in the face, legs and arms, and severe headache. Rarely, malignant hypertension may also cause brain swelling, which can result in hypertensive encephalopathy which is a serious condition and symptoms of which are: blindness, confusion, changes in mental status, coma, drowsiness, worsening headache, seizures, nausea and vomiting.

High blood pressure makes it difficult for the kidneys to filter toxins and wastes from the blood. High blood pressure is the leading cause of kidney failure. If the patient develops malignant hypertension, then the kidneys can suddenly stop functioning.

The diagnosis of malignant hypertension is made based on the patient’s blood pressure readings and signs of severe organ damage.

If the patient has symptoms of malignant hypertension, the doctor will:

• Recheck the patient’s blood pressure.
• Listen to the patient’s lungs and heart for abnormal sounds.
• The eyes are checked to look for damage to the retinal blood vessels and optic nerve swelling.
• Other tests are done which consist of blood and urine tests and which include: Blood clotting tests, blood sugar level, sodium levels, potassium levels, complete blood count,

blood urea nitrogen (BUN) and creatinine levels which will be high in case of kidney damage. Urinalysis is done to check for protein, blood, or abnormal hormone levels which are associated with kidney problems. Other blood tests are also done based on the results of the above tests.

Imaging Tests Which Are Done Include:

• Echocardiogram is done to assess the heart function and blood flow through the heart.
• Chest x-ray is done to look at the size and shape of the heart structures and to check for fluid in the lungs.
• Electrocardiogram (ECG) is done to check the electrical function of the heart.
• Further imaging tests are done to evaluate the arteries and the function of the kidneys.

Malignant hypertension is a medical emergency and it requires prompt medical attention in an intensive care unit of the hospital. Physical exam of the patient is done and an assessment of the patient’s symptoms and general health is done and then the treatment plan for the patient is decided. The aim of treatment for Malignant Hypertension is to carefully decrease the patient’s high blood pressure within a matter of minutes. Intravenous blood pressure medicines are given which is the fastest way to treat extremely high blood pressure. Once the patient’s blood pressure acquires a safe level, then the patient is given oral medications. If the patient develops kidney failure, then kidney dialysis may be needed.

Other treatments are done depending on the causes of the malignant hypertension and patient’s specific symptoms.

Malignant hypertension is a medical emergency and if it is not treated, then it can cause many complications and even death of the patient. Prompt medical treatment decreases the chances for development of life-threatening complications.

The complications of malignant hypertension are:

• Pulmonary edema, where the patient has fluid in the lungs.
• Aortic dissection, where there is an abrupt sudden rupture of the main blood vessel which exits the heart.
• Heart attack.
• Heart failure.
• Stroke.
• Sudden kidney failure.
• Coma.

Also Read:

• Retroperitoneal Mass or Tumor: Types, Signs, Symptoms, Investigations- MRI, CT Guided Biopsy
• Primary Pulmonary Hypertension: Who Is At Risk, Is It Serious Disease, Symptoms, Diagnosis, Treatment
• Pulmonary Arterial Hypertension: Causes, Who Is At Risk, Is It A Serious Condition, Symptoms, Treatment
• Hypertensive Heart Disease – Causes, Symptoms, Diagnosis, Treatment