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What is Malignant Hypertension? Print E-mail
Written by Adrian Wozniak   
Tuesday, 27 October 2009

Malignant Hypertension
Malignant hypertension refers to extremely high blood pressure that can cause injury to the eyes, heart, brain, and kidneys. This can result in permanent damage to these organs and even death.

What is going on in the body?

Uncontrolled severe hypertension, or high blood pressure, causes injury to the blood vessels within the kidney, brain, heart, and eyes.

What are the causes and risks of the disease?
Many individuals have diagnosed high blood pressure. If it is left untreated, the high blood pressure can lead to malignant hypertension in a small percentage of these people. Malignant hypertension is very rare in a person with no history of high blood pressure.

What are the treatments for the disease?
If the malignant hypertension is caused by another condition, treating the underlying condition may lower blood pressure. There are many medications used to treat high blood pressure, including:
- diuretics, such as hydrochlorothiazide/triamterene or furosemide
- beta-blockers, such as propranolol or atenolol
- angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril
- angiotensin II receptor blockers, such as losartan or valsartan
- vasodilators, such as hydralazine
- centrally acting nervous system medications, such as clonidine

Calcium channel blockers, such as diltiazem, nifedipine, or verapamil, have been used for over 20 years to treat high blood pressure. However, the findings of 2 recent studies show that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medications for high blood pressure. The findings of one study, for example, showed that the risk of heart attack was 27% greater, and the risk of congestive heart failure was 26% higher. The American Heart Association recommends discussing the risks and benefits of the medication with a healthcare provider.

The choice of medication varies depending on the person's medical history. Beta- blockers usually are not prescribed for someone who has breathing problems such as asthma or emphysema. ACE inhibitors and diuretics to reduce fluid buildup are especially useful for an individual with kidney disease or diabetes. A person with high blood pressure may be on multiple medications.

The goal of treatment is to keep the top number of the blood pressure below 140 and the bottom number below 90. In a person with diabetes, the goal is to keep the top number below 130 and the bottom number below 85. For an individual with heart disease or kidney disease, the goal is to get the blood pressure as low as can be tolerated.

What are the side effects of the treatments?

Side effects vary according to the medications used. Beta- blockers can worsen asthma. Diuretics can cause dehydration and salt imbalance. Calcium channel blockers can cause swelling of the legs, as well as a higher risk of heart attack and congestive heart failure. ACE inhibitors may lead to chronic dry cough.

What happens after treatment for the disease?
A person who has malignant hypertension needs to continue taking the prescribed medications every day. Blood pressure may return to normal with weight loss, increased physical activity, reduction of alcohol intake, and a diet low in sodium. In most cases a person will need to continue to take blood pressure medications for life.

How is the disease monitored?
Malignant hypertension is monitored through frequent visits to a healthcare professional. A person with high blood pressure often records blood pressure readings in between office visits. Any new or worsening symptoms should be reported to the healthcare provider.


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