MedlinePlus Medical Encyclopedia: Malignant hypertension (arteriolar nephrosclerosis)

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Malignant hypertension (arteriolar nephrosclerosis)

Contents of this page:
Illustrations Alternative names Definition Causes, incidence, and risk factors Symptoms Signs and tests	Treatment Expectations (prognosis) Complications Calling your health care provider Prevention

Illustrations

Hypertensive kidney

Alternative names Return to top

Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant

Definition Return to top

Malignant hypertension is usually defined as very high blood pressure with swelling of the optic nerve behind the eye, called papilledema (grade IV Keith-Wagner hypertensive retinopathy). Malignant hypertension is usually accompanied by other organ damage like heart failure, kidney failure, and hypertensive encephalopathy.

Causes, incidence, and risk factors Return to top

The disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy, and people with kidney disorders or collagen vascular disorders. You are at high risk for malignant hypertension if you have had kidney (renal) failure or renal hypertension caused by renal artery stenosis.

Malignant hypertension is a medical emergency. Many body systems are in serious risk due to the extreme elevation of blood pressure. Multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys may sustain damage. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and kidney failure may develop, which may be permanent.

Symptoms Return to top

blurred vision
headache
change in mental status
- restlessness
- anxiety
- decreased alertness, decreased ability to concentrate
- fatigue
- sleepy, stuporous, lethargic
- confused, delirious
chest pain
- mid chest location most common
- crushing or pressure sensation
shortness of breath
cough
decreased urinary output
nausea or vomiting
seizure
weakness of the arms, legs, face, or other areas
abnormal sensation (numbness) of the arms, legs, face, or other areas

Signs and tests Return to top

Your blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure, including papilledema (swelling of the optic nerve), retinal bleeding, or infarction (cotton wool spots or soft exudate -- fluid with cellular debris) in the retina. If not already present, kidney failure may develop as a complication of malignant hypertension. Other complications may also develop.

Damage to the kidneys may be demonstrated by:

BUN increase
Creatinine increase
Arterial blood gas analysis showing metabolic acidosis
Urinalysis showing high proteinlevels (especially with kidney impairment) or microscopic blood in the urine)

A chest X-ray may indicate pulmonary (lung) congestion from fluid forced into the lungs by heart failure as a consequence of the high blood pressure.

This disease may also alter the results of the following tests:

Treatment Return to top

Hospitalization is essential until the severe high blood pressure is under control. Medications delivered through an IV line, such as nitroprusside, nitroglycerin, or others, may reduce your blood pressure.

After the severe high blood pressure is brought under control, anti-hypertensive medications taken by mouth can control your blood pressure. The medication may need to be adjusted occasionally. Hypertension can be difficult to control.

Expectations (prognosis) Return to top

If treated promptly, malignant hypertension is often controlled without permanent complications. If it is not treated promptly, complications may be severe and life-threatening.

Complications Return to top

recurrence of malignant hypertension episodes
damage to the brain from:
- hypertensive encephalopathy
- spasm or constriction of the arteries of the brain
- swelling
- stroke
- seizures
- intracerebral hemorrhage
- coma
pressure damage to the eyes, permanent blindness
pressure damage to the heart
- decreased cardiac output
- heart attack
- angina
pulmonary edema
kidney failure

Calling your health care provider Return to top

Go to the emergency room or call your local emergency number (such as 911) if symptoms of malignant hypertension develop. This is an emergency condition!

Call your health care provider if you know you have poorly controlled high blood pressure.

Prevention Return to top

If you have high blood pressure, carefully monitoring your blood pressure and taking your medicines properly help to reduce the risk.

Update Date: 10/29/2003

Updated by: Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.

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