Malignant Hypertension

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....is not the same as accelerated hypertension but malignant hypertension is the worst classification of severe high blood pressure. Learn how to prevent it by reading this doctor’s guide:

(Malignant Hypertension has papilledema which is swelling of the optic nerve seen in the retina at the back of the eye; Accelerated Hypertension does not.)


Severe Hypertension Including Malignant Hypertension:

Definition: A systolic level greater than 180 mm and a diastolic level greater than 120 mm Hg.

The main issue of classification is the time within which blood pressure must be lowered.

Three Categories of Severe Hypertension:

  1. Chronic Hypertension Poorly Controlled:

    • History: Usually that of high blood pressure, usually poorly controlled. Maybe headache.

    • Examination: Negative. No target organ damage detected.

    • Laboratory and tests: Negative. No target organ damage detected.

    • Therapy: Observe for 1 to 3 hours, oral medication and follow-up in 3 to 7 days.

  2. Hypertensive Urgency:

    • History: Headache more likely and more severe. Anxiety, maybe nosebleed.

    • Examination: Negative. Blood pressure higher.

    • Laboratory and tests: Negative.

    • Therapy: Observe for 1 to 3 hours, oral medication and follow-up in 1 to 2 days.

  3. Malignant Hypertension (Hypertensive Emergency):

    • History: Symptoms of the blood pressure itself or an underlying problem. (See below)

    • Examination: Blood pressure 220 over 140 mm Hg. Other findings according to the underlying problem.

    • Laboratory and tests: Abnormalities on CT scan, EKG, chest X-ray, and/or urinalysis.

    • Therapy: Parenteral (IV or IM) in the ER followed by in-patient care. Reduction must be within hours.

Malignant Hypertension:

This is the most severe of the three classes of Severe Hypertension and is an emergency. The Symptoms, Physical Findings and Test Abnormalities are a function of whether they are caused directly by the severity of the high blood pressure or by another abnormality causing organ damage resulting in secondary hypertension. This secondary high blood pressure may also contribute to further organ damage.

An example of primary MH would be hypertensive encephalopathy where the pressure is hurting the brain directly and causing it to swell.

An example of secondary MH might be hemorrhagic stroke causing increased blood pressure in the brain which must be followed by increased general blood pressure. The pressure outside the brain must always be higher than the pressure inside the brain or else no blood flows through.

Doctor’s Practical Guide:

The main lesson to be learned here is that you should not let yourself get into the situation where you have severe high blood pressure as outlined above. YOU CAN:

  • Prevent your blood pressure from becoming abnormal.

  • Lower it by natural means if it does go up. See other pages on lowering blood pressure. (Navigation bars at left of this page.)

  • Keep excellent track of it by taking it yourself. It’s easy. See this page on How and Why at How To Take Blood Pressure

  • Take your medicine regularly if all else fails. We have the medications necessary to control just about anyone.

  • Follow-up regularly with your doctor.

If you do these things as necessary there is very little chance you will end up in one of those scenarios outlined above. But to obtain the numerous accurate readings that are necessary you really should learn to take your own blood pressure.

Take care of yourself. Examine the contents of my booklet on How To Take Your Own Blood Pressure at How To Take Blood Pressure Booklet


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