Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosis

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Prognosis

Malignant hypertension is a medical emergency. It can lead to permanent central nervous system (CNS), cardiovascular, and renal damage if left untreated.

An episode may be categorized as ahypertensive emergencywhen systolic blood pressure (the top number) is 180 millimeters of mercury (mmHg) or higher, diastolic blood pressure (the bottom number) is 120 mmHg or higher, and there is the presence of end-organ damage.

Severe and life-threatening complications may be avoided with prompt medical treatment aimed at gradually reducing blood pressure levels.

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A healthcare provider checks medical record and monitors in caring for a person in a hospital bed

Malignant Hypertension Symptoms

Symptoms of malignant hypertensioninclude:

In severe cases, untreated malignant hypertension can lead to:

MHT is relatively rare, occurring in less than 1% of people with hypertension.The most common cause of MHT isuncontrolled hypertension, but the following conditions may also lead to MHT:

What Is Malignant Hypertension?

Diagnosis of malignant hypertensionstarts with a healthcare provider taking a detailed history and vital signs. A focused physical examination will include taking the blood pressure in both arms, aneurological examination, and afundoscopic eye examination.

If signs of neurological damage are present, a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain may be used to look for signs of damage.

Anelectrocardiogram (EKG or ECG), echocardiogram, and cardiac biomarkers can help check for arrhythmias or heart damage.

Blood urea nitrogen (BUN) and creatinine levels may be measured to assess kidney damage. Aurinalysisis a quick and widely available way to check for protein or blood in your urine, which are signs of renal damage.

While there is some debate on the exact definition and diagnostic criteria for MHT, generally, a diagnosis of malignant hypertension can be made in the presence of very high blood pressure readings in one or both arms (usually 180/120 mmHg) and any sign of acute damage in one or more organs, such as flame-shaped hemorrhages or soft exudates on your eye exam.

MHT is a medical emergency.Treatment should be administered in a hospitalunder medical supervision. Referral to specialists, surgery, dialysis, and even kidney transplant may be needed. Hypertensive medications must be given via an intravenous (IV) line to take effect faster than oral medication.

Medical management to gradually reduce blood pressure is the gold standard treatment for malignant hypertension. The best hypertensive treatment for you will be based on the cause of your MHT.

Intravenous (IV) beta-blockers (labetalol, propranolol, or esmolol) and calcium channel blockers (nicardipine and clevidipine) are first-line treatments for MHT when detected in its early stages. IV nitroglycerin may be used in more severe cases based on its rapid onset of action.

Nitroprusside may be used in cases of MHT that present with intracranial bleeding, swelling of the brain (encephalopathy), heart attack, or aortic dissection. Hydralazine may be used in hypertensive cases in pregnancy (preeclampsia).

Reducing your blood pressure under the guidance of a medical professional is especially important because an overly aggressive approach can lead to a harmful reduction in organ blood flow (hypoperfusion) and more serious organ damage.

Those who receive a prompt diagnosis and appropriate antihypertensive treatment generally have a good prognosis. The time from diagnosis to treatment is critically important because the disease tends to progress rapidly toward permanent end organ damage.

Untreated MHT has a mortality rate of 80% within two years. Even with treatment, MHT can be deadly, with one study reporting a nearly 7% hospital mortality rate and a 37% readmission rate within 90 days across 25 U.S. hospitals.

Summary

A Word From Verywell

Survival rates have improved dramatically for MHT due to advances in clinical treatment. Still, the key to avoiding serious medical complications is to receive medical treatment as soon as possible if you are experiencing any of the aforementioned symptoms.

Even after successful treatment, you may need to see your healthcare provider for follow-up appointments to screen for secondary hypertension, help catch complications, and mitigate any lingering issues.

MHT can affect any person at any age. But smokers, Black Americans, and people with a history of drug use or kidney damage are more likely than others to get MHT. They should check with a healthcare provider regularly to manage their blood and discuss lifestyle changes (like quitting smoking) that can help reduce the risk of MHT recurrence.

13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Waldron FA, Benenson I, Jones-Dillon SA, et al.Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019;28(2):114-123. doi:10.1080/08037051.2019.1568183Mount Sinai.Malignant hypertension.American Heart Association.Hypertensive crisis: when you should call 911 for high blood pressure.Brokmann JC, Rossaint R, Müller M, et alBlood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care.J Clin Hypertens (Greenwich). 2017;19(7):704-712. doi:10.1111/jch.13026Riemekasten G.Progress in systemic sclerosis - early, targeted and intensive therapy is the key to success.Dtsch Med Wochenschr. 2019;144(3):189-193. doi:10.1055/a-0652-2488Prestige ER.Malignant hypertension - causes, symptoms, complications.Liu S, Song A, Zhou X, Kong X, Li WA, Wang Y, Liu Y.Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: literature review with one case report.Medicine (Baltimore). 2017;96(44):e8535. doi:10.1097/MD.0000000000008535Mir D, Ardabilygazir A, Afshariyamchlou S, Sachmechi I.Malignant hypertension in association with low estrogen dose oral contraceptives: case report and review of literature.Cureus. 2018;10(7):e2978. doi:10.7759/cureus.2978MedlinePlus.Coarctation of the aorta.Boulestreau R, van den Born BH, Lip GYH, Gupta A.Malignant hypertension: current perspectives and challenges.JAHA. 2022;11(7):e023397. doi:10.1161/JAHA.121.023397van den Born B-JH, Lip GYH, Brguljan-Hitij J, et al.ESC Council on hypertension position document on the management of hypertensive emergencies.Eur Hear J. 2019;5:37–46. doi:10.1093/ehjcvp/pvy032Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34Domek M, Gumprecht J, Lip GYH, Shantsila A.Malignant hypertension: does this still exist?J Hum Hypertens. 2020;34(1):1-4. doi:10.1038/s41371-019-0267-y

13 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Waldron FA, Benenson I, Jones-Dillon SA, et al.Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019;28(2):114-123. doi:10.1080/08037051.2019.1568183Mount Sinai.Malignant hypertension.American Heart Association.Hypertensive crisis: when you should call 911 for high blood pressure.Brokmann JC, Rossaint R, Müller M, et alBlood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care.J Clin Hypertens (Greenwich). 2017;19(7):704-712. doi:10.1111/jch.13026Riemekasten G.Progress in systemic sclerosis - early, targeted and intensive therapy is the key to success.Dtsch Med Wochenschr. 2019;144(3):189-193. doi:10.1055/a-0652-2488Prestige ER.Malignant hypertension - causes, symptoms, complications.Liu S, Song A, Zhou X, Kong X, Li WA, Wang Y, Liu Y.Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: literature review with one case report.Medicine (Baltimore). 2017;96(44):e8535. doi:10.1097/MD.0000000000008535Mir D, Ardabilygazir A, Afshariyamchlou S, Sachmechi I.Malignant hypertension in association with low estrogen dose oral contraceptives: case report and review of literature.Cureus. 2018;10(7):e2978. doi:10.7759/cureus.2978MedlinePlus.Coarctation of the aorta.Boulestreau R, van den Born BH, Lip GYH, Gupta A.Malignant hypertension: current perspectives and challenges.JAHA. 2022;11(7):e023397. doi:10.1161/JAHA.121.023397van den Born B-JH, Lip GYH, Brguljan-Hitij J, et al.ESC Council on hypertension position document on the management of hypertensive emergencies.Eur Hear J. 2019;5:37–46. doi:10.1093/ehjcvp/pvy032Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34Domek M, Gumprecht J, Lip GYH, Shantsila A.Malignant hypertension: does this still exist?J Hum Hypertens. 2020;34(1):1-4. doi:10.1038/s41371-019-0267-y

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Waldron FA, Benenson I, Jones-Dillon SA, et al.Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019;28(2):114-123. doi:10.1080/08037051.2019.1568183Mount Sinai.Malignant hypertension.American Heart Association.Hypertensive crisis: when you should call 911 for high blood pressure.Brokmann JC, Rossaint R, Müller M, et alBlood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care.J Clin Hypertens (Greenwich). 2017;19(7):704-712. doi:10.1111/jch.13026Riemekasten G.Progress in systemic sclerosis - early, targeted and intensive therapy is the key to success.Dtsch Med Wochenschr. 2019;144(3):189-193. doi:10.1055/a-0652-2488Prestige ER.Malignant hypertension - causes, symptoms, complications.Liu S, Song A, Zhou X, Kong X, Li WA, Wang Y, Liu Y.Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: literature review with one case report.Medicine (Baltimore). 2017;96(44):e8535. doi:10.1097/MD.0000000000008535Mir D, Ardabilygazir A, Afshariyamchlou S, Sachmechi I.Malignant hypertension in association with low estrogen dose oral contraceptives: case report and review of literature.Cureus. 2018;10(7):e2978. doi:10.7759/cureus.2978MedlinePlus.Coarctation of the aorta.Boulestreau R, van den Born BH, Lip GYH, Gupta A.Malignant hypertension: current perspectives and challenges.JAHA. 2022;11(7):e023397. doi:10.1161/JAHA.121.023397van den Born B-JH, Lip GYH, Brguljan-Hitij J, et al.ESC Council on hypertension position document on the management of hypertensive emergencies.Eur Hear J. 2019;5:37–46. doi:10.1093/ehjcvp/pvy032Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34Domek M, Gumprecht J, Lip GYH, Shantsila A.Malignant hypertension: does this still exist?J Hum Hypertens. 2020;34(1):1-4. doi:10.1038/s41371-019-0267-y

Waldron FA, Benenson I, Jones-Dillon SA, et al.Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019;28(2):114-123. doi:10.1080/08037051.2019.1568183

Mount Sinai.Malignant hypertension.

American Heart Association.Hypertensive crisis: when you should call 911 for high blood pressure.

Brokmann JC, Rossaint R, Müller M, et alBlood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care.J Clin Hypertens (Greenwich). 2017;19(7):704-712. doi:10.1111/jch.13026

Riemekasten G.Progress in systemic sclerosis - early, targeted and intensive therapy is the key to success.Dtsch Med Wochenschr. 2019;144(3):189-193. doi:10.1055/a-0652-2488

Prestige ER.Malignant hypertension - causes, symptoms, complications.

Liu S, Song A, Zhou X, Kong X, Li WA, Wang Y, Liu Y.Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: literature review with one case report.Medicine (Baltimore). 2017;96(44):e8535. doi:10.1097/MD.0000000000008535

Mir D, Ardabilygazir A, Afshariyamchlou S, Sachmechi I.Malignant hypertension in association with low estrogen dose oral contraceptives: case report and review of literature.Cureus. 2018;10(7):e2978. doi:10.7759/cureus.2978

MedlinePlus.Coarctation of the aorta.

Boulestreau R, van den Born BH, Lip GYH, Gupta A.Malignant hypertension: current perspectives and challenges.JAHA. 2022;11(7):e023397. doi:10.1161/JAHA.121.023397

van den Born B-JH, Lip GYH, Brguljan-Hitij J, et al.ESC Council on hypertension position document on the management of hypertensive emergencies.Eur Hear J. 2019;5:37–46. doi:10.1093/ehjcvp/pvy032

Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34

Domek M, Gumprecht J, Lip GYH, Shantsila A.Malignant hypertension: does this still exist?J Hum Hypertens. 2020;34(1):1-4. doi:10.1038/s41371-019-0267-y

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