Topic Overview

Malignant high blood pressure (malignant hypertension) is very high blood pressure that comes on suddenly and is an emergency. If not treated, it can damage the brain, heart, eyes, or kidneys.

Symptoms include numbness, blurry vision, chest pain, severe headache, and confusion.

This problem is also called hypertensive crisis or hypertensive emergency.

Quick-acting medicines are used to lower blood pressure.

The cause may be unknown. Or the problem may be caused by medicine or another condition.

When to call a doctor

Call your doctor now or seek immediate care if:

• Your blood pressure is much higher than normal (such as 180/110 or higher).
• You think high blood pressure is causing symptoms, such as:
  • Severe headache.
  • Blurry vision.

What problems does malignant high blood pressure cause?

Malignant high blood pressure can cause:

• Bleeding in your brain or body.
• Heart attack.
• Heart failure.
• Kidney failure.
• Eye damage and loss of vision.

How can you prevent it?

It is better to prevent episodes of malignant high blood pressure than to treat an episode after you have already had one. One of the most common causes of malignant high blood pressure is not taking your blood pressure medicines properly. Sometimes this happens unintentionally. For example, your prescription may run out or you may forget to take a dose. But try to stay on your medicine schedule as best as you can. Another cause of malignant blood pressure is illegal drug use, such as stimulants like cocaine.

How is it treated?

To treat malignant high blood pressure, doctors and nurses will carefully monitor your blood pressure and give you medicine intravenously (through a needle inserted in one of your veins). The immediate goal is to lower your blood pressure enough so that your organs are no longer in immediate danger. But it must be lowered slowly so that your body has enough time to adjust to the change in blood pressure. If blood pressure is lowered too quickly, your body may have a hard time getting blood to your brain.

The other goal of treatment is to treat organ complications. For example, your doctor may give you a diuretic if you have fluid buildup in your lungs. Or your doctor may give a beta-blocker and nitrates if you have myocardial ischemia (not enough blood is reaching your heart). After your doctor has lowered your blood pressure to a safe level and treated your complications, he or she will try to identify the cause of the acute episode. Your doctor will then work with you to create a treatment regimen that can help prevent future attacks.

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