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Malignant Hypertension: 7 Things To Know

Posted on April 26, 2023
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Medically reviewed by
Steven Kang, M.D.
Article written by
Emily Wagner, M.S.

Malignant hypertension — also known as a hypertensive crisis — is caused by sudden, extreme spikes in blood pressure that can damage your organs. While you’re more likely to develop malignant hypertension if you have chronically high blood pressure, it can affect anyone. Certain risk factors play into your chances of developing malignant hypertension, including having underlying health conditions and taking certain medications.

Although malignant hypertension is rare, it’s important to understand your risk and to know the symptoms so you can get it treated as quickly as possible. In this article, we’ll discuss seven things to know about malignant hypertension including the risk factors, symptoms, and treatment options.

1. There Are Two Types of Malignant Hypertension

Malignant hypertension is divided into two types — hypertensive urgency and hypertensive emergency. Hypertensive urgency is diagnosed when you have abnormally high blood pressure without signs of organ damage. This condition can be treated with oral antihypertensives (blood pressure drugs), and you’ll require continued monitoring over time.

On the other hand, a hypertensive emergency involves extremely high blood pressure with symptoms of organ damage. This is a medical emergency that needs to be addressed immediately to stop organ damage.

2. Anyone Can Develop Malignant Hypertension, but Certain Factors Increase Your Risk

You’re at a higher risk of developing malignant hypertension if you have elevated blood pressure, which can be caused by factors such as an unhealthy diet or certain genetics. Hypertension from these types of nonmedical causes is known as essential hypertension. It’s possible to live with high blood pressure for years before developing malignant hypertension. Malignant hypertension affects only about 1 percent of people with essential hypertension.

Studies also show that up to 60 percent of malignant hypertension cases develop in people without a history of high blood pressure.

Having certain health conditions can increase your risk of developing malignant hypertension, including:

  • Heart disease
  • Diabetes
  • Obesity
  • Preeclampsia and eclampsia (high blood pressure during or shortly after pregnancy)

Additionally, your risk can increase if you:

  • Use oral contraceptives (birth control pills) or monoamine oxidase inhibitors (MAOIs) for treating depression
  • Use cocaine or amphetamines
  • Suddenly stop taking blood pressure medication, which causes withdrawals

Race and ethnicity may play a role in the risk of malignant hypertension. Some studies have found that malignant hypertension is around 3.5 times more prevalent among white people than Black people.

The condition is also more common in young adults.

3. Symptoms of Malignant Hypertension Depend on Which Organs Are Affected

Your blood pressure is measured using two numbers expressed as a fraction. The top number is your systolic blood pressure, and the bottom is your diastolic blood pressure. A healthy blood pressure reading is less than 120/80 milligrams of mercury (mm Hg). Malignant hypertension is diagnosed when your blood pressure is greater than 180/120 mm Hg.


The symptoms of malignant hypertension can vary depending on what organs are affected by high blood pressure. You may develop a condition known as hypertensive encephalopathy, which is a collection of symptoms caused by extremely high blood pressure. Symptoms of this condition include:

  • Headache
  • Nausea
  • Vomiting
  • Confusion, anxiety, or restlessness
  • Weakness in your face, arms, or legs
  • Seizures

Cardiovascular Symptoms

Cardiovascular symptoms of malignant hypertension may be caused by pulmonary edema, a buildup of fluid in your lungs. This can cause angina (chest pain) or a squeezing or pressing sensation in addition to shortness of breath.

Long-term high blood pressure can also cause dilated cardiomyopathy, a heart condition that causes the lower chambers of the heart to stretch and become larger. This condition weakens your heart, making it harder to pump blood to other parts of your body. In addition to chest pain and shortness of breath, you may also have heart palpitations and feel dizzy or fatigued.

Kidney Symptoms

If malignant hypertension has damaged your kidneys, your symptoms will look similar to those seen in kidney disease. Your kidneys are responsible for maintaining your body’s fluid balance and excreting waste and water as urine. In malignant hypertension, your kidneys may make less urine than usual. Instead, your body hangs on to the extra fluid, causing your feet and legs to begin swelling.

Eye Symptoms

The blood vessels in your eyes are extremely delicate and sensitive to changes in blood pressure. Abnormally high blood pressure levels in malignant hypertension can cause several eye complications, leading to blurry vision.

Papilledema — swelling of the optic nerve, which connects your eyes and brain — is a tell-tale symptom of malignant hypertension. This is typically caused by intracranial pressure (increased pressure in your skull). The blood vessels in the back part of your eye, known as the retina, can also become damaged or narrowed.

4. Health Conditions That Raise Your Blood Pressure May Contribute to Malignant Hypertension

Your nervous system and kidneys work together to control your blood pressure levels. This system is typically well-regulated to keep your levels within a normal range. However, some diseases and injuries can interfere with this system, and cause spikes in blood pressure.

Other conditions that can cause malignant hypertension include:

  • Renal artery disease — A disease that affects the arteries (large blood vessels) that bring oxygenated blood from the heart to the kidneys
  • Adrenal disorders — Disorders such as Cushing’s disease and pheochromocytoma that increase the production of the hormones cortisol and aldosterone, which raise your blood pressure
  • Thyroid disorders — Imbalances in your thyroid hormones that can increase your blood pressure
  • Brain or central nervous system injuries — Damage to your brain and spinal cord caused by a stroke, traumatic brain injury, or bleeding that interferes with your body’s ability to control your blood pressure
  • Collagen vascular disorders — Autoimmune disorders that attack your body’s skin and joints, including rheumatoid arthritis and systemic lupus erythematosus

5. Malignant Hypertension Is Diagnosed With Blood Work and Organ-Specific Tests

Your doctor may use several tests to diagnose malignant hypertension, depending on the symptoms you’re experiencing. They’ll start with a physical exam to measure your heart rate, blood pressure, and temperature. If they find your blood pressure is abnormally high, they’ll then run tests to look for any organ damage.

Examples of tests your doctor may order include:

  • Chest X-ray — Checks for fluid in your lungs or an enlarged heart
  • Electrocardiogram (ECG) — Monitors your heart’s rhythm for any signs of a heart attack or heart damage
  • Urinalysis — Tests your kidney function to check for abnormalities in the urine
  • Eye exam — Looks for swelling of the optic nerve and any damage to your retina
  • Blood work — Measures hormone levels, kidney function, and proteins related to heart damage

6. Hypertensive Emergency Requires Emergency Medical Treatment

If you think you’re having a hypertensive emergency, get to the emergency room as quickly as possible. It’s important to lower your blood pressure immediately to prevent lasting organ damage. You’ll be given intravenous (IV) blood pressure medication, and you’ll likely have to stay in the hospital for a few days until your blood pressure is under control.

One of the most commonly used medications for malignant hypertension is sodium nitroprusside. It quickly relaxes and opens your blood vessels, allowing more blood to flow through them. Other IV medications you may receive to help lower your blood pressure include:

Once your blood pressure is under control with IV medication, you’ll be switched to oral medication to manage your pressure over the long term. Sticking to your treatment plan after you’re released from the hospital can help prevent other health complications in the future.

7. Hypertensive Urgency Is Managed With Oral Blood Pressure Medications

Since hypertensive urgencies aren’t associated with organ damage, they don’t often require an emergency room visit. Instead, they’re mostly treated with oral blood pressure medications that help gradually lower your levels. The goal of treating hypertensive urgency is to help you maintain healthy blood pressure levels over the long term. There currently isn’t much available research on which medications are best for treating hypertensive urgency. Your doctor will determine which treatment option is best for you based on your overall health and symptoms.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 56,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you living with malignant hypertension? How do you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on April 26, 2023
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    All updates must be accompanied by text or a picture.
    Steven Kang, M.D. is the Director of Cardiac Electrophysiology at Alta Bates Summit Medical Center and Alameda Health Systems in Oakland, California. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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