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Malignant hypertension is a medical emergency with a sudden and rapid increase in blood pressure, causing organ damage. Treatment involves drugs to lower blood pressure and addressing the underlying cause. Ongoing monitoring and treatment may be necessary, especially for kidney damage.
Malignant hypertension is a medical emergency characterized by a sudden and very rapid increase in blood pressure. If left untreated, the patient may develop a coma and eventually die, and even with treatment, patients with malignant hypertension are at risk of organ damage. Treatment for this condition is usually given in a hospital setting until the patient’s blood pressure stabilizes, at which point the patient may be discharged to begin outpatient treatment, which usually includes monitoring blood pressure for signs of changes which could signal a return of dangerously high blood pressure.
Usually, the onset of malignant hypertension is related to an ongoing disease process, such as kidney disease. In other cases, there’s no clear cause. People with malignant hypertension experience symptoms such as swelling in the legs and feet, nausea, vomiting, dizziness, confusion, and eye bleeding caused by a dangerous increase in pressure in the blood vessels that supply the eye. Many also develop fluid around the heart and lungs.
The concern with malignant hypertension is that the organ damage that can occur over years of systemic hypertension can occur over days or even hours. A patient’s systolic blood pressure can be over 220, with diastolic blood pressure over 130, and this can cause a very rapid onset of organ damage, particularly to the eyes and kidneys. If high blood pressure persists, the brain can also be damaged and permanent damage can result.
Immediate treatment for malignant hypertension is drugs to lower the patient’s blood pressure, aiming at a safer and more stable level. Once the patient is comfortable, diagnostic tests can be done to find out why the patient’s blood pressure has skyrocketed and to treat the underlying cause. For example, more aggressive treatment for kidney disease may be needed to address a decline in kidney function. This may involve a medical team to address multiple areas of concern when it comes to patient care.
The patient may also need to continue the treatment of their existing hypertension. This may include medications to keep the blood pressure at a reasonably low level, along with ongoing monitoring, especially if the patient has developed organ damage as a result of the malignant hypertension episode. Because this condition is often linked to kidney damage, the patient may need to work with a nephrologist who can evaluate the health of the kidneys and develop a monitoring and treatment plan with the patient.
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