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Malignant Hypertension (Arteriolar Nephrosclerosis)
Malignant hypertension is a rare and severe condition in which blood pressure is dangerously high. Learn more about symptoms and treatments.

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What Is Malignant Hypertension?

Hypertension, or high blood pressure, is a common condition that affects 1 in 3 Americans. High blood pressure is diagnosed if one or both of the following occur:

  • Your systolic blood pressure is consistently over 140.
  • You diastolic blood pressure is consistently over 90.

High blood pressure is generally manageable if you follow your doctor’s advice.

Although it’s not common, some people with high blood pressure may have a rapid rise in blood pressure above 180/120 mm Hg. This is known as malignant hypertension. This condition is sometimes referred to as arteriolar nephrosclerosis.

Malignant hypertension requires immediate medical attention. If you don’t get emergency treatment, you may develop serious health problems, such as a heart attack, stroke, or kidney failure.

What Are the Symptoms of Malignant Hypertension?

High blood pressure is commonly referred to as the “silent killer” because it doesn’t always have obvious signs or symptoms. Unlike moderate high blood pressure, malignant hypertension has very noticeable symptoms that include:

  • changes in vision including blurred vision
  • chest pain
  • a cough
  • anxiety
  • nausea or vomiting
  • numbness or weakness in the arms, legs, or face
  • shortness of breath
  • a headache
  • reduced urine output

Malignant hypertension can also result in a condition known as hypertensive encephalopathy. The symptoms of this disorder include:

  • severe headache
  • blurry vision
  • confusion
  • lethargy
  • seizure

What Causes Malignant Hypertension?

Malignant hypertension mostly occurs in people with a history of high blood pressure. It’s also more common in African-Americans, males, and people who smoke. It’s especially common in people whose blood pressure is above 140/90 mm Hg. About 1 percent of people with high blood pressure develop malignant hypertension.

Some health issues increase your chances of having malignant hypertension. These include:

  • kidney disorders or kidney failure
  • the use of drugs like cocaine, amphetamines, birth control pills, or monoamine oxidase inhibitors (MAOIs), which are a class of antidepressant medication
  • pregnancy and preeclampsia, which occurs when a woman develops high blood pressure and protein in the urine in the late 2nd to 3rd trimester of pregnancy
  • autoimmune diseases, which are a result of the body making antibodies against its own tissues
  • spinal cord injuries causing parts of the nervous system to become overactive
  • renal stenosis, which is a narrowing of the arteries of the kidneys
  • a narrowing of the aorta, which is the main blood vessel leaving the heart
  • aortic dissection, which is bleeding along the wall of the aorta
  • not taking your medication for high blood pressure

In some cases, these symptoms may not be due to malignant hypertension. They may be related to other health conditions that are less serious. However, malignant hypertension is so serious that you should seek emergency medical help if you have any of these symptoms. Your doctor will be able to provide you with more information about your condition.

How Is Malignant Hypertension Diagnosed?

Your doctor will ask you about your health history including any treatments you’re on for high blood pressure. They’ll also measure your blood pressure. This will help to determine whether or not emergency treatment is needed.

Determining Organ Damage

Other tests may be used to see if your condition has resulted in organ damage. For instance, blood tests measuring BUN and creatinine levels may be ordered. BUN stands for blood urea nitrogen, which measures the amount of waste product from the breakdown of protein in the body. Creatinine is a chemical produced by the breakdown of muscles. Your kidneys clear it from your blood. When the kidneys aren’t functioning normally, these tests will be abnormal. Your doctor may also order the following:

  • an echocardiogram or ultrasound to look for heart damage
  • a urine test to measure proteins caused by kidney damage
  • an electrocardiogram (EKG) to measure the electrical functioning of the heart
  • a renal ultrasound to look for additional kidney problems
  • an eye exam to determine if damage to the eye has occurred

How Is Malignant Hypertension Treated?

Malignant hypertension is a medical emergency. You need to get treatment for it immediately to lower your blood pressure and avoid dangerous complications. Typically, treatment includes using high blood pressure medications given intravenously, which means they go directly into your bloodstream through a vein in your arm. This allows for immediate action. These medications are called antihypertensive medications.

Once your blood pressure has been stabilized, your doctor will prescribe oral blood pressure medications. These medications will enable you to control your blood pressure at home. If you’re diagnosed with malignant hypertension, you’ll need to follow your doctor’s recommendations. This will include having regular checkups to monitor your blood pressure.

How Can Malignant Hypertension Be Prevented?

Some cases of malignant hypertension can be prevented. If you have high blood pressure, it’s important for you to check your blood pressure regularly. It’s also important for you to take all prescribed medications without missing any doses. Also, try to maintain a healthy lifestyle and follow your doctor’s advice. Seek immediate treatment if you get any of the associated symptoms. You’ll need urgent care to help reduce organ damage.

Tips to Lower Your Blood Pressure

The following are tips to lower your blood pressure

  • Adopt the Dietary Approaches to Stop Hypertension (DASH) diet, which includes eating fruits, vegetables, low-fat dairy products, foods high in potassium, whole grains, and avoiding or limiting saturated fat.
  • Limit your salt intake to 1,500 milligrams per day if you’re African-American, over 50 years old, or if you have diabetes, hypertension, or chronic kidney disease. Keep in mind that processed foods can be high in sodium.
  • Exercise for a minimum of 30 minutes per day.
  • Lose weight to get to a healthier weight for your height and body size.
  • Learn stress management techniques, such as deep breathing or meditation.
  • If you smoke, quit smoking.
  • Try to limit alcoholic drinks to two per day if you’re a man and one drink per day if you’re female or over 65 years old.
  • Use a device at home to watch your blood pressure.
Written by: Darla Burke
Edited by:
Medically Reviewed by: [Ljava.lang.Object;@72b0144
Published: Jun 15, 2012
Published By: Healthline Networks, Inc.
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