Malignant Hypertension Treatment Saves Lives

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What is malignant hypertension?

Malignant hypertension is a form of high blood pressure that is severe. When a patient is suffering from malignant hypertension, it is considered a medical emergency. It is estimated that sixty-five million patients suffer with this hypertensive condition each year. Usually the blood pressure is 210/120 mm Hg. Unlike a hypertensive crisis, this condition can cause other severe symptoms that could lead to eye, heart, kidney, and brain damage. Early treatment is important because it usually will lead to death within 3 to 6 months, if not sooner.

What are the treatment options?

The malignant hypertension treatment will depend on the severity of the condition and the results of the blood lab work that the physician will order to determine what the patient’s condition is. In severe cases, the physician will place the patient in ICU to be monitored closely. The blood pressure must be lowered rapidly, so antihypertensive medications are given intravenously. This drug therapy will help to bring the blood pressure down to a safe level to prevent damage or further damage to other vital organs. The intravenous medications most commonly used are fenoldopam, nicardipine, esmolol, sodium nitroprusside, clevidipine, and labetalol. Other medications that may be used are:

  • Diuretics
  • Adrenergic blockers
  • Centrally acting alpha-agonist
  • Angiotensin-converting enzyme (Ace) Inhibitors
  • Angiotensin II blockers
  • Calcium channel blockers
  • Direct vasodilators

Are there any risk or side effects involved in drug therapy?

The answer is yes, there can be some risk and side effects in this type of treatment. Side effects from medications include:

  • Dizziness
  • Depression
  • Fluid retention
  • Headache
  • Drowsiness
  • Dry mouth
  • Fatigue
  • Insomnia
  • Vivid dreams
  • Hallucinations
  • Lethargy
  • Shortness of breath
  • Heartburn
  • Fainting

The risk involved may consist of rapid heartbeat (tachycardia), slow heart rate (bradycardia), heart failure, renal failure, bleeding of peptic ulcer, enlarged gums, and sexual dysfunction.

It is vitally important that a physician monitor the patient’s condition in case any modification of the medication being administered needs to be adjusted.

Are there any other treatments?

There are other treatments that the doctor may order for the patient to follow. He may request that the patient stay on complete bed rest until his or her blood pressure is under control. The doctor may require that the patient fast until stability is maintained. Once the patient is stable, the patient may be prescribed a low salt diet. The physician may also indicate a diet to induce weight loss if needed. It will be important to follow the malignant hypertension treatment that the doctor prescribes. Usually after the crisis has passed, the patient can move on to normal activity in their daily lives.

On A Special Note

It will be important for the patient to monitor their blood pressure on a routine bases and to follow up on all doctor visits. All medications should be taken as prescribed, even if the patient feels better. Most of the time patients do not feel any different when their blood pressure is running high. This sometimes makes it tempting for the patient to stop taking their medication. Doing so could be very dangerous or even fatal.


John D Bisognano, MD, PhD, FACP, FACC, Professor of Medicine, Director of Outpatient Cardiology, University of Rochester Medical Center

American College Of Physicians;57/3/441

Merck Manual of Medical Information Hypertension Malignant second Home Edition page 131,134 and 141