Malignant Hypertension: A Life-Threatening Emergency

Most of us are aware that hypertension is bad for our health in the long run. Luckily, blood pressure can be managed with a combination of diet, exercise, and medications. However, what happens when you don’t take the necessary precautions to control your blood pressure? Malignant hypertension occurs when a person’s blood pressure skyrockets to dangerously high levels. Keep reading to find out more about this potentially life-threatening condition and how to treat it.

Stages of hypertension

Normally, blood pressure should be below 120/80 mmHg (systolic pressure over diastolic pressure, in millimeters of mercury). Once the systolic pressure goes over 120 mmHg, this is already considered an elevated blood pressure reading.

Stage 1 hypertension is classified as having a systolic pressure between 130 to 139 mmHg or a diastolic pressure of 80 to 89 mmHg. This is the stage when a doctor would normally diagnose a patient with hypertension. Unfortunately, many people do not get checked often enough and end up being first diagnosed with stage 2 hypertension. A hypertensive crisis happens if blood pressure surpasses 180/120 mmHg and can cause stroke, making it a medical emergency.

However, it is important to note that a person’s blood pressure naturally varies depending on a variety of factors. Some factors include the method of measurement, time of day, and whether you are sitting or laying down. While occasional fluctuations in blood pressure is normal, prolonged elevation is a cause for concern.

Defining malignant hypertension

Building on the different stages mentioned above, malignant hypertension is a syndrome that includes a rapid and excessive rise in blood pressure accompanied by retinopathy. Retinopathy is damage to the blood vessels to the retina of the eyes. Because the retinas are essential for vision, lack of blood flow or destruction of the vessels leads to symptoms such as blurring or loss of sight.

Like a hypertensive crisis, malignant or accelerated hypertension is a medical emergency.

Some of the causes or factors that contribute to uncontrolled blood pressure include:

• Not complying with your prescribed medications
• Suddenly stopping or underdosing of antihypertensive medications 
• Taking certain medications (e.g. stimulants, amphetamines)
• Renal artery stenosis
• Kidney disease
• Endocrine dysfunction (e.g. pheochromocytoma)
• Central nervous system disorders (e.g. brain trauma)

How dangerous is malignant hypertension?

The word “malignant” is usually associated with cancer. Although malignant hypertension is not a type of cancer, it is just as scary. The biggest danger of elevated blood pressure is the damage it does to the blood vessels throughout the body.

Large arteries, such as the aorta, are designed to withstand large volumes and pressures for longer periods of time. On the other hand, the smaller, more delicate arteries that surround organs like the eyes, brain, and kidneys can be irreversibly damaged by sudden spikes or prolonged hypertension. Thus, malignant hypertension leads to increased morbidities and fatalities.

However, hypertensive emergencies are not that common due to the widespread use of antihypertensive medications and diets such as DASH.

What are the treatment options for malignant hypertension

If you suspect that you or someone you know is experiencing malignant hypertension, seek medical attention right away. It is imperative to lower high blood pressure as soon as possible to prevent or reduce organ damage.

The goal of treatment is to quickly but carefully lower blood pressure to a safe range. It is not ideal to drop blood pressure too steeply, as it can result in ischemia (loss of blood flow and oxygenation) to areas with rich blood supply.

As general management, lower the mean arterial pressure up to 20% within the first hour then further decrease it by 5 to 15% over the next 24 hours. Instead of oral antihypertensive drugs that malignant hypertension requires intravenous (IV) administration because these work faster.

Common drugs used in the hospital to lower blood pressure in hypertensive emergencies include:

• Nitrates (e.g. nitroprusside)
• Calcium channel blockers (e.g. nicardipine)
• Beta-blockers (e.g. labetalol, esmolol)

After recovery, it is important to consistently monitor and control blood pressure every day. Take all medications at the right time and at the right dose. In addition, try doing cardiovascular exercise several times a week while limiting the amount of salt and cholesterol in your diet.

Learn more about Hypertension here.