Malignant high blood pressure and its complications

An episode of malignant high blood pressure, which is also called hypertensive crisis or hypertensive emergency, occurs when your blood pressure is much higher than normal. It may occur because the signals in your body that control your blood pressure suddenly become unbalanced. Sometimes the blood pressure may even double.

Although rare, malignant high blood pressure poses a risk of immediate organ damage and is a medical emergency that requires going to the emergency room. Severe high blood pressure can cause bleeding in your brain, heart attack, heart failure, kidney failure, damage to your retina, and loss of vision. In some cases, you may not be able to repair or reverse this damage.

The table below tells you how malignant high blood pressure can affect your organs.

Complications of malignant high blood pressure



Symptoms and effects

Bleeding in your brain Blood vessel rupture Symptoms that resemble a stroke, including:
  • Severe headache
  • Paralysis
  • Numbness
  • Tingling
  • Loss of consciousness
Heart attack or angina Insufficient blood flow to your heart muscle
  • Pain/pressure in your chest
  • Pain/tingling in your left arm
  • Shortness of breath
Heart failure Heart cannot pump blood against very high arterial pressure and becomes “congested”
  • Acute shortness of breath after minor exertion or even at rest
Kidney failure Damage to your kidneys’ filtering system because of excessive pressure and debris from damaged blood cells
  • Usually no noticeable symptoms
  • Maybe bloody urine
Retinal damage Bleeding into the eye, causing retinal detachment and tissue death
  • Loss of vision
Aortic dissection Excessive pressure separates the inner wall of your aorta (your body’s largest artery, originating at the heart) from its outer wall, potentially disrupting blood supply to various organs.

Severe pain, often in the back—between shoulder blades—or chest

  • Collapse of the circulatory system
  • Heavy internal bleeding
  • Effect depends on which branches are affected

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.

An acute episode can occur if your essential hypertension gets worse or if you develop a new cause of secondary high blood pressure, such as sudden kidney failure. It is not always possible to keep your condition from getting worse. But it helps if you and your doctor monitor your blood pressure carefully.

Warning signs of mild malignant high blood pressure include headache, blurry vision, and vomiting. Warning signs for severe malignant high blood pressure include severe headache, blurry vision, chest pain, acute shortness of breath, and blood in your urine. If you have high blood pressure and you start to have these symptoms, call your doctor or go to the hospital immediately.

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 develop a treatment regimen that can help prevent future attacks.

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