Malignant high blood pressure (malignant hypertension) is very high blood pressure that comes on suddenly and is an emergency. If not treated, it can damage the brain, heart, eyes, or kidneys.
Symptoms include numbness, blurry vision, chest pain, severe headache, and confusion.
This problem is also called hypertensive crisis or hypertensive emergency.
Quick-acting medicines are used to lower blood pressure.
The cause may be unknown. Or the problem may be caused by medicine or another condition.
When to call a doctor
Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/110.
For example, call 911 if:
You have symptoms of a heart attack. These may include:
Chest pain or pressure, or a strange feeling in the chest.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.
You have symptoms of a stroke. These may include:
Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble understanding simple statements.
Sudden problems with walking or balance.
A sudden, severe headache that is different from past headaches.
You have severe back or belly pain.
Do not wait until your blood pressure comes down on its own. Get help right away.
Call your doctor now or seek immediate care if:
Your blood pressure is much higher than normal (such as 180/110 or higher), but you don’t have symptoms.
You think high blood pressure is causing symptoms, such as:
Watch closely for changes in your health, and be sure to contact your doctor if:
Your blood pressure measures 140/90 or higher at least 2 times. That means the top number is 140 or higher or the bottom number is 90 or higher, or both.
You think you may be having side effects from your blood pressure medicine.
Your blood pressure is usually normal, but it goes above normal at least 2 times.
What problems does malignant high blood pressure cause?
Malignant high blood pressure can cause:
Bleeding in your brain or body.
Eye damage and loss of vision.
How can you prevent it?
It is better to prevent episodes of malignant high blood
pressure than to treat an episode after you have already had one. One of the
most common causes of malignant high blood pressure is not taking your blood
pressure medicines properly. Sometimes this happens unintentionally. For
example, your prescription may run out or you may forget to take a dose. But
try to stay on your medicine schedule as best as you can. Another cause of
malignant high blood pressure is illegal drug use, such as stimulants like cocaine.
How is it treated?
To treat malignant high blood pressure,
doctors and nurses will carefully monitor your blood pressure and give you
medicine intravenously (through a needle inserted in one of your veins). The
immediate goal is to lower your blood pressure enough so that your organs are
no longer in immediate danger. But it must be lowered slowly so that your body
has enough time to adjust to the change in blood pressure. If blood pressure is
lowered too quickly, your body may have a hard time getting blood to your
The other goal of treatment is to treat organ
complications. For example, your doctor may give you a diuretic if you have
fluid buildup in your lungs. Or your doctor may give a beta-blocker and
nitrates if you have myocardial ischemia (not enough blood is reaching your
heart). After your doctor has lowered your blood pressure to a safe level and
treated your complications, he or she will try to identify the cause of the
acute episode. Your doctor will then work with you to create a treatment
regimen that can help prevent future attacks.
Atkins GB, et al. (2011). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst’s the Heart, 13th ed., vol. 2, pp. 1585-1605. New York: McGraw-Hill.
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD – Internal Medicine Martin J. Gabica, MD – Family Medicine Kathleen Romito, MD – Family Medicine Specialist Medical ReviewerRobert A. Kloner, MD, PhD – Cardiology