Malignant Hypertension: Should you be Worried?

Hypertension or high blood pressure is defined as the force of blood on the arterial walls. Malignant hypertension is the most severe type of blood pressure and often develops rapidly. When your blood pressure levels are at 120/80mm Hg, they are said to be normal. It is one of the high blood types often treated as a severe condition or medical emergency.

Compared to hypertension, malignant hypertension is relatively low. 2 in every 1,00,000 Caucasians tend to develop this severe form of high blood pressure. People of African-American descent are at higher risk of developing this condition.

Understanding Malignant Hypertension

Here’s all that you need to know about the disease:

Causes and Common Symptoms

The primary cause of malignant blood pressure is pre-existing hypertension. In others, missing their blood pressure medication dosage can develop severely high blood pressure levels. Other causes of this high blood pressure type include:

• Collagen vascular disease (scleroderma)
• Kidney conditions
• Injury to the spinal cord
• Adrenal gland tumours
• Certain medications like oral contraceptives and MAOIs
• Illegal drugs like cocaine
• Pregnancy-induced hypertension (called toxaemia)

Common signs and symptoms of malignant hypertension to look out for are:

• Headache
• Nausea
• Vomiting
• Blurring of vision
• Cough
• Numbness in the extremities
• Reduced urine output
• Chest pain and shortness of breath
• Changes in mental status such as reduced concentration, fatigue, tiredness, drowsiness, and stupor
• Weakness in the arms and legs
• Seizures

Brain swelling may occur in rare cases leading to hypertensive encephalopathy characterised by blindness, confusion, and coma.

Risk Factors

As we saw earlier, malignant hypertension is comparatively rare. Less than 1% of people with hypertension develop this condition. Some risk factors for this type of hypertension are:

• Gender: Men are more likely to develop this condition
• Race: People of African-American descent
• Poor access to healthcare
• Lower socioeconomic strata

Diagnosis

Although malignant hypertension is a medical emergency, diagnosing it can be slightly tricky. Diagnosis of this condition usually depends upon blood pressure readings, symptoms and signs of acute organ damage.

First, your doctor will perform a physical examination to look for:

• Extremely high blood pressure reading
• Swelling in the legs and feet
• Abnormal heart sounds
• Fluid in the lungs
• Changes in one’s reflexes, the way they think and behave

The doctor will also perform an eye examination to look for signs of high blood pressure, such as:

• Retinal bleeding
• Narrowing of retinal blood vessels
• Swelling of the optic nerve
• Other retinal issues

Since high blood pressure significantly impacts kidney functioning, you may be required to undergo tests to determine kidney damage. These may include:

• Blood Urea Nitrogen (BUN) test
• Arterial blood gas analysis
• Creatinine
• Urinalysis
• Kidney ultrasound

If any abnormality is detected in the lungs, a chest x-ray may be used to detect lung congestion or enlarged heart.

Other tests that may be required to diagnose malignant hypertension include:

• Renin level
• ECG
• Determining the level of aldosterone
• Detecting the presence of cardiac enzymes (they act as markers of brain damage)
• Urinary sediment
• CT scan of the brain

Treatment

Malignant blood pressure is considered a medical emergency, and rightly so. It requires immediate medical attention in a hospital setting. When patients with this disease are brought to the hospital, they are mostly shifted to the intensive care unit. After evaluating the signs and symptoms, and assessing the patient’s medical history, the doctor and healthcare team will begin treatment immediately to bring down the blood pressure levels.

The patient may be given antihypertensive medication via IV to lower blood pressure levels. Once the blood pressure is brought down to the normal range, the doctor may change the medicines to the oral form. Patients who develop kidney failure may require dialysis.

Patients may require additional treatments depending upon the patient’s symptoms and causes of malignant hypertension.

Complications

Malignant hypertension requires immediate treatment. When not treated, this condition can result in complications such as:

• Sudden rupture of one of the main blood vessels in the heart
• Accumulation of fluid in the lungs (called pulmonary edema)
• Permanent blindness
• Brain damage triggering seizures or stroke
• Heart attack
• Heart failure
• Sudden kidney failure
• Coma

Above mentioned life-threatening symptoms, when not treated immediately, can result in death.

Prevention

The most effective way to prevent the malignant rise in blood pressure levels is to regularly take your medications as prescribed and monitor your blood pressure levels. It would help if you visited your doctor regularly to check your blood pressure levels. Making lifestyle changes to maintain a healthy blood pressure level is also effective in preventing malignant hypertension.

Conclusion

Not everyone with hypertension will develop a malignant form of the disease. However, this does not reduce your risk. If you are hypertensive and notice one or more signs and symptoms of malignant hypertension, consult your doctor immediately.

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