Malignant Hypertension

(Hypertensive Emergency; Hypertensive Crisis; Hypertensive Urgency)

Definition

Malignant hypertension is blood pressure that is so high that it is actually causing damage to organs, particularly in the nervous system, the cardiovascular system, and/or the kidneys. One type of such damage is called papilledema, a condition in which the optic nerve leading to the eye becomes dangerously swollen, threatening vision. This is a serious condition that requires immediate care. Rapid treatment can prevent long-term problems. Left untreated, damage from malignant hypertension occurs quickly and can be severe, involving organ damage to blood vessels, the eyes, heart, spleen, kidneys, and brain. In particular, kidney failure may develop since the blood vessels inside the kidneys are very sensitive to high blood pressure.
Cardiovascular System and Kidneys
Placement of Blood Pressure Cuff
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Causes

In addition to having high blood pressure , medical conditions leading to the development of malignant hypertension include:
  • History of kidney disorders or failure.
  • Taking certain drugs or medications, including cocaine, amphetamines, monoamine oxidase inhibitors (MAOIs), and oral contraceptives.
  • History of collagen vascular diseases.
  • Pregnant women with preeclampsia and eclampsia.
  • Pheochromocytoma.
  • Spinal cord disorders.
  • Coarctation or dissection of the aorta.
  • Renal artery stenosis or narrowing of the arteries to the kidneys.
  • Missing doses of prescribed antihypertensive medications, particularly beta-blockers or clonidine, which can cause a rebound effect. Medication noncompliance is the most common reason for hypertensive emergencies.

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