Malignant Hypertension

Medically Reviewed by James Beckerman, MD, FACC on November 06, 2019

Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. Normal blood pressure is below 120/80. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency.

What Causes Malignant Hypertension?

In many people, high blood pressure is the main cause of malignant hypertension. Missing doses of blood pressure medications can also cause it. In addition, there are certain medical conditions that can cause it. They include:

Who's at Risk for Malignant Hypertension?

Malignant hypertension is rare. About 1% of people who have a history of high blood pressure develop this life-threatening condition.

You are at greater risk of developing it if you are a man, African-American, or someone of lower economic status. Poor access to health care increases the risk.

What Are the Symptoms of Malignant Hypertension?

The main symptoms of malignant hypertension are a rapidly increasing blood pressure of 180/120 or higher and signs of organ damage. Usually, the damage happens to the kidneys or the eyes.

Other symptoms depend on how the rise in blood pressure affects your organs. A common symptom is bleeding and swelling in the tiny blood vessels in the retina. The retina is the layer of nerves that line the back of the eye. It senses light and sends signals to the brain through the optic nerve, which can also be affected by malignant hypertension. When the eye is involved, malignant hypertension can cause changes in vision.

Other symptoms of malignant hypertension include:

In rare cases, malignant hypertension can cause brain swelling, which leads to a dangerous condition called hypertensive encephalopathy. Symptoms include:

High blood pressure, in general, makes it difficult for kidneys to filter wastes and toxins from the blood. It is a leading cause of kidney failure. Malignant hypertension can cause your kidneys to suddenly stop working properly.

How Is Malignant Hypertension Diagnosed?

A diagnosis of malignant hypertension is based on blood pressure readings and signs of acute organ damage.

If you have symptoms of malignant hypertension, the doctor will:

  • Recheck your blood pressure and listen to your heart and lungs for abnormal sounds
  • Examine your eyes to check for damage to the blood vessels of the retina and swelling of the optic nerve
  • Order blood and urine tests that may include:
    • Blood urea nitrogen (BUN) and creatinine levels, which increase if you have kidney damage
    • Blood clotting tests
    • Blood sugar (glucose) level
    • Complete blood count
    • Sodium and potassium levels
    • Urinalysis to check for blood, protein, or abnormal hormone levels related to kidney problems

Additional blood tests may be needed, depending on the result of the tests listed above.

The doctor will also ask for imaging tests, including:

  • Echocardiogram to check heart function and blood flow through the heart
  • Electrocardiogram (ECG) to check the heart’s electrical function
  • Chest X-ray to look at the shape and size of the heart structures and to detect fluid in the lungs
  • Other imaging tests to evaluate the kidneys and their arteries

How Is Malignant Hypertension Treated?

Malignant hypertension is a medical emergency and needs to be treated in a hospital, often in an intensive care unit. The doctor will consider your symptoms and overall health when deciding what treatment plan is best for you. The goal of treatment is to carefully lower your blood pressure within a matter of minutes.

You will receive blood pressure medicines through an IV, which is the quickest way to treat extremely high blood pressure. Once blood pressure is at a safe level, the medications may be switched to oral forms. If you develop kidney failure, you may need kidney dialysis.

Other treatments depend on your specific symptoms and possible causes of the malignant hypertension.

What Are Complications of Malignant Hypertension?

Untreated, malignant hypertension causes death. Complications of malignant hypertension also may include:

  • Aortic dissection, which is a sudden rupture of the main blood vessel leaving the heart
  • Coma
  • Fluid in the lungs, called pulmonary edema
  • Heart attack
  • Heart failure
  • Stroke
  • Sudden kidney failure

Immediate medical treatment decreases your chances for life-threatening complications.

WebMD Medical Reference



American Heart Association: "Understanding Blood Pressure Readings" and "Hypertensive Crisis."

Merck Manual Home Edition: "Heart and Blood Vessel Disorders: High Blood Pressure."

The Mount Sinai Medical Center: "Malignant Hypertension."

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