High blood pressure is often called the "Silent Killer" This is because it often has no warning signs or symptoms. Malignant hypertension is a severe emergency which is characterized by a severe rise in the blood pressure which cannot then be lowered. It is diagnosed by the presence of advanced retinopathy in the presence of a diastolic blood pressure of over 120 mm Hg.



Malignant hypertension is defined as very high blood pressure with swelling of the optic nerve behind the eye called papilledema (grade IV Keith-Wagner hypertensive retinopathy). Malignant hypertension is accompanied with damage to organs such as hypertensive encephalopathy, kidney and heart.

Malignant hypertension is more prevalent in African type people and also more common in smokers. It affects about 1% of those people already suffering with high blood pressure. It is also known to occur in younger people (even children), and also in pregnancy.

In malignant hypertension, there is usually a characteristic rush or increase in the blood pressure often for no apparent reason. Because it is very difficult to reduce a malignant blood pressure, it can and will cause the vital organs of the body irreparable harm. This can include the brain, eyes, heart, kidneys and blood vessels. (They are all put under tremendous pressure).

Those suffering from malignant hypertension may also complain of:

? Confusional periods

? Decreased urinary output

? Headaches

? Vomiting

? Abnormal sensations to the arms, legs and other areas.

? Some visual disturbances.

? Change in their mental state

? Restlessness and anxiety

? Decreased alertness and ability to think and concentrate

? Extreme fatigue

? Chest pain

? Shortness of breath and cough

The prognosis of people suffering from malignant hypertension can be bleak, as the damage caused to the body is often life threatening especially to older people suffering from malignant hypertension. The common caused of death is renal failure, stroke and especially cardiac.

Some commonly used drugs for treatment are:

?IV fenoldopam (which is the most common).

?Labetalol is another common treatment, which provides a good transition from IV to oral (PO) dosing.

?Beta-blockade can be performed intravenously with esmolol or metoprolol treatments.

?Hydralazine is usually only reserved for use in pregnant patients

?phentolamine is used as the drug of choice for a pheochromocytoma crisis.

Any treatment given to a person suffering with malignant hypertension, should be given carefully as a sudden decrease in the blood pressure from very high levels can be just as dangerous as a blood pressure kept at a consistently high level. Malignant blood pressure should be decreased (if possible) gradually over a period of at least a week with very carefully prescribed anti hypertensive drugs. Complete bed rest is also often prescribed to ensure complete rest is taken.

With a current effective therapy in place, including dialysis, the survival rate after 1 year is over 90%, and after 5 years it is over 80%. If it is treated promptly, malignant hypertension can be controlled without any further complications. However the person suffering with malignant hypertension should be monitored very carefully.