Malignant hypertension is usually defined as very high blood pressure with swelling of the optic nerve behind the eye. The swelling of the optic nerve behind the eye is called papilledema.

The disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy, and persons with kidney disorders or collagen vascular disorders.

You are at high risk for malignant hypertension if you have had kidney failure or renal hypertension caused by renal artery stenosis.

• Abnormal sensation (numbness) of the arms, legs, face, or other areas
• Blurred vision
• Change in mental status
  • Restlessness
  • Anxiety
  • Decreased alertness, decreased ability to concentrate
  • Fatigue
  • Sleepiness, stuporous, lethargic
  • Confusion
• Chest pain
  • Mid-chest location most common
  • Crushing or pressure sensation
• Cough
• Decreased urinary output
• Headache
• Nausea or vomiting
• Seizure
• Shortness of breath
• Weakness of the arms, legs, face, or other areas

Malignant hypertension is a medical emergency.

Blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure, including swelling of the optic nerve, retinal bleeding, or other problems with the retina.

If not already present, kidney failure may develop as a complication of malignant hypertension. Other complications may also develop.

Tests to determine damage to the kidneys may include:

• BUN
• Creatinine
• Arterial blood gas analysis
• Urinalysis

A chest x-ray may show lung congestion. The congestion results from fluid forced into the lungs by heart failure as a consequence of the high blood pressure.

This disease may also alter the results of the following tests:

• Aldosterone
• Renin
• Urinary casts