Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis - arteriolar; Hypertension - malignant; High blood pressure - malignant

• 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.

A physical exam commonly shows:

• Extremely high blood pressure
• Possible swelling in the lower legs and feet
• Abnormal heart sounds and fluid in the lungs
• Changes in mental status, sensation, muscle ability, and reflexes

An eye examination will reveal changes that indicate high blood pressure, including swelling of the optic nerve, retinal bleeding, narrowing of the blood vessels in the eye area, 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 and an enlarged heart.

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

• Aldosterone
• Cardiac enzymes (markers of heart damage)
• Electrocardiogram (EKG)
• Renin
• Urinary casts (sediment)

Images

Hypertensive kidney

Review Date: 04/20/2009
Reviewed By: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)