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Malignant Hypertension

A life-threatening condition with extremely high blood pressure accompanied by retinal and renal target organ damage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Malignant Hypertension?

Malignant hypertension is defined as systolic blood pressure above 180 mmHg and diastolic above 120 mmHg accompanied by target organ damage such as retinal hemorrhage, papilledema, acute kidney injury, or hypertensive encephalopathy.

Pathophysiology involves endothelial dysfunction, fibrinoid necrosis, and microangiopathic hemolysis. Thrombocytopenia, schistocytes, and elevated LDH may accompany.

The treatment goal is to reduce mean arterial pressure by 20-25% in the first hour, followed by gradual normalization over 24 hours. Excessively rapid reduction increases the risk of ischemic stroke.

Symptoms

Severe headache
Blurred vision and scotoma
Nausea, vomiting
Chest pain and shortness of breath
Muscle weakness and confusion
Decreased urine output
Epistaxis

Risk Factors

Uncontrolled chronic hypertension
Medication non-compliance
Renal artery stenosis (renovascular hypertension)
Pheochromocytoma
Cocaine, amphetamine use
Background of preeclampsia in pregnancy
Autoimmune diseases (scleroderma)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If blood pressure is over 180/120 mmHg and symptomatic, go to the emergency department immediately
  • Call 112 for severe headache, visual disturbance, or chest pain
  • Do not delay with headache and high blood pressure during pregnancy
  • Present if blood pressure cannot be controlled in patients with kidney disease

Treatment Methods

01
Intravenous labetalol, nicardipine, or nitroprusside infusion
02
Goal: 20-25% reduction in MAP in the first hour
03
Close monitoring with central and arterial catheters
04
Investigation of underlying cause (renal Doppler, metanephrines)
05
Electrolyte and renal function follow-up
06
Transition to oral antihypertensives after treatment

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.