Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. "Normal" blood pressure is below 140/90. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency.
Any of the following may be performed to detect damage to the heart or blood vessels:
Electrocardiogram (ECG) is a noninvasive test that detects the electrical activity of the heart and records it on paper. ECG is helpful for evaluating for damage of the heart muscle, such as heart attack, and/or thickening/hypertrophy of the heart wall/muscle, common complications of high blood pressure.
Echocardiogram is an ultrasound examination of the heart taken through the chest. Sound waves take a picture of the heart as it beats and relaxes and then transmits these images to a video monitor. The echocardiogram can detect problems with the heart such as enlargement, abnormalities in motion of the heart wall, blood clots, and heart valve abnormalities. It also gives a good measurement of the strength of the heart muscle (ejection fraction). The echocardiogram is more comprehensive than an ECG, but also more expensive.
A plain chest x-ray primarily provides an estimate of the size of the heart, but it is much less specific than echocardiography, which provides more detail.
Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, a common finding in people with high blood pressure. It also can depict the arteries to both kidneys and sometimes depicts narrowings that can lead to high BP in a minority of patients.