Malignant hypertension can kill

Malignant hypertension refers to an advanced condition where the patient's blood pressure is elevated to very high levels. Systolic pressures are typically above 200 mmHg and diastolic pressures greater than 140 mmHg. Malignant hypertension is also known as accelerated hypertension.

At these extreme blood pressures, the patient may suffer damage to their brain, kidneys, lungs or eyes. Symptoms like blurred vision and headaches may be present.

Patients with malignant hypertension are sometimes hospitalized with what are called hypertensive emergencies. Chest pain occurs in about one in four patients and is one of the most common symptoms of this condition.

Dyspnea or shortness of breath is also common and occurs in approximately one in five patients. Neurologic problems occur in about the same number of patients.

Cardiac problems like myocardial infraction, angina and pulmonary edema may be caused by malignant hypertension. Neurological problems include cerebral hemorrhage, headaches, vision disturbances and other issues like changes in mental states, vomiting, retinopathy accompanied by papilledema (swelling of the optic disc caused by very high intercranial pressure) and seizures.

Hypertensive emergencies can have a number of causes. If the patient has been on beta-blockers for a while, sudden withdrawal of the medication may cause this problem. Using steroids, oral contraceptives, monoamine oxidase inhibitors (MAOIs), alpha-stimulants or cocaine are known to cause hypertensive emergencies in some cases. The use of alcohol by patients susceptible to this condition can be a cause as well.

Patients with malignant hypertension may suffer from renal failures. Some develop gastrointestinal problems including nausea and vomiting.

Aortic dissection is one of the conditions associated with extreme hypertension. This refers to tearing of the aorta wall, which is a potentially fatal condition. Aortic coarctation is another associated condition where a portion of the aorta becomes narrowed. Patients with malignant hypertension may have their blood pressure checked on both arms and even the legs, to uncover the presence of these conditions.

There are several medications used for treating severely high blood pressure. If the patient requires intravenous drug delivery, labetalol is often used because it is easy to transition from intravenous delivery to oral consumption. Another commonly used medications is called IV fenoldopam. Pregnant women are often prescribed Hydralazine. Beta blockers are also used in many cases - examples include metoprolol and esmolol. Some patients with specific complications may be given phentolamine.

In earlier years, the life expectancy for patients with malignant hypertension was just two years. In most cases, the death occurred due to strokes, heart failures or failure of the kidneys. At the one year milestone, the survival rate was just one in four, while the survival rate at five years was less than one in a hundred.

Today, with more effective medication and greater use of dialysis, survival rates have improved dramatically. The one year survival rate has risen to 90% while the five year rate is as much as 80%. Kidney failure continues to be a common complication that develops with malignant hypertension.

Given early detection and the right treatment, malignant hypertension need not be the killer it once was. Adopting a balanced lifestyle and having regular checkups done go a long way towards containing this serious health problem.

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