Clinical syndrome of markedly high blood pressure with retinal hemorrhages and retinal exudates, and often including confusion, headaches, vomiting, and visual disturbances.

Alternative Names

Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant

Causes, incidence, and risk factors

Malignant hypertension is a medical emergency condition where there is a severe rise in the blood pressure . The cause is unknown, but there is often a prior history of hypertension , especially hypertension resulting from kidney disorders (secondary hypertension). The disorder affects about 1% of hypertension patients including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy , and people with renal or collagen vascular disorders . A history of acute renal failure or renal hypertension caused by renal artery stenosis indicates a high risk for malignant hypertension. There is a sudden, rapid increase in blood pressure, usually for no observable cause. The disorder can cause severe, permanent, life-threatening consequences from pressure damage to multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and acute renal failure may develop; this renal failure may be permanent.

Signs and tests

Blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure , including papilledema ( swelling of the optic nerve), retinal bleeding, or infarction (cotton wool spots or soft exudate -- fluid with cellular debris) in the retina . If not already present, acute renal failure may develop as a complication of malignant hypertension. Other complications may also develop. Damage to the kidneys may be demonstrated by:

a

BUN increase

a

creatinine increase

arterial blood gas analysis

shows

metabolic acidosis

urinalysis

shows high

protein levels (especially with kidney impairment) or microscopic hematuria ( blood in the urine ) A chest X-ray may indicate pulmonary (lung) congestion from fluid forced into the lungs by heart failure as a consequence of the high blood pressure. This disease may also alter the results of the following tests:

urinary casts

renin

aldosterone

Treatment

Hospitalization is essential until the severe

high blood pressure is under control. Intravenous medications such as nitroprusside, nitroglycerin, or others may reduce blood pressure . After the acute hypertension is brought under control, oral (by mouth) anti-hypertensive medications can maintain control of the blood pressure. The medication may need to be adjusted occasionally. Hypertension can be difficult to control.

Expectations (prognosis)

If treated promptly, malignant hypertension is often controlled without permanent complications. If it is not treated promptly, complications may be severe and life-threatening.

Complications

recurrence of malignant hypertension episodes

damage to the brain from:

hypertensive encephalopathy

spasm or constriction of the arteries of the brain

cerebral

edema

stroke

seizures

intracerebral hemorrhage

coma

pressure damage to the eyes, permanent

blindness

pressure damage to the heart

decreased cardiac output

heart attack

angina

pulmonary edema

acute renal failure

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms of malignant hypertension develop. This is an emergency condition!

Call your health care provider if known hypertension is poorly controlled.

Prevention

Careful monitoring of blood pressure in people known to be hypertensive and close compliance with the medical treatment for hypertension help to reduce the risk.