Accelerated Hypertension

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is accelerated hypertension?

Accelerated hypertension (also called malignant hypertension) is a disease characterized by a rapid and sudden increase in blood pressure over the baseline level that, if untreated, poses a threat of damage to organs and tissues.

Accelerated hypertension is an uncommon cardiovascular disease in the United States. In contrast, approximately one-third of U.S. adults have essential or secondary hypertension.

It is not known why accelerated hypertension develops in some people with hypertension and not in others.

The signs and symptoms of accelerated hypertension occur suddenly and represent a medical emergency. People with accelerated hypertension have extremely high blood pressure that poses a risk of serious or life-threatening symptoms if untreated. Fortunately, accelerated hypertension can be treated successfully with antihypertensive medications.

Left untreated, accelerated hypertension can progress to hypertensive emergency and result in organ damage. Severe organ damage can cause stroke, blindness, kidney failure, or coma and may be life threatening. Seek prompt medical care if you develop headache, irregular heartbeat, nosebleed, or vision changes. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of extremely high blood pressure, such as chest pain or pressure, cough, shortness of breath, blurred vision, confusion, reduced urine production, nausea or vomiting, or seizure.

What are the symptoms of accelerated hypertension?

Accelerated hypertension causes a dramatic increase in blood pressure. No other symptoms may be present when the initial rise in blood pressure occurs, but if the high blood pressure is not treated, there is a risk of hypertensive emergency with damage to multiple organs.

Common symptoms of hypertensive emergency

A hypertensive emergency may develop if accelerated hypertension is not promptly treated. Symptoms of severe hypertension can include:

  • Blurred or double vision
  • Buzzing in the ear
  • Confusion or loss of consciousness for even a brief moment
  • Headache
  • Irregular heartbeat
  • Loss of vision or changes in vision
  • Nausea and vomiting
  • Weakness

Serious symptoms that might indicate a life-threatening condition

In some cases, accelerated hypertension can lead to a life-threatening situation. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Blurred or double vision
  • Chest pain or pressure
  • Confusion or loss of consciousness for even a brief moment
  • Difficulty breathing
  • Reduced urine production
  • Seizures and tremor

What causes accelerated hypertension?

Accelerated hypertension is caused by a rapid progression of existing hypertension. Hypertension itself is influenced by factors such as genetics, lifestyle, and drug use. Hypertension occurs most frequently in men and in people who are African American, have heart disease, diabetes, and kidney disease, smoke cigarettes, or take drugs that increase blood pressure.

Hypertension may also be caused by kidney failure, or by high blood pressure in the kidneys (renal hypertension) due to narrowing of the renal artery, toxemia of pregnancy, or vascular disorders. It can occur among cocaine users and in people who take certain medications such as appetite suppressants, birth control pills, certain cold medications, corticosteroids, and migraine medications.

What are the risk factors for accelerated hypertension?

A number of factors increase the risk of developing hypertension. It is not known why some people with hypertension develop accelerated hypertension while others do not. Not all people with risk factors will get accelerated hypertension. Risk factors for hypertension include:

Reducing your risk of accelerated hypertension

You may be able to lower your risk of accelerated hypertension by:

  • Avoiding drugs that increase blood pressure
  • Eating a healthy, low-fat, low-salt diet
  • Monitoring your blood pressure
  • Taking your medications properly

How is accelerated hypertension treated?

Treatment for hypertension begins with seeking medical care from your health care provider. Hypertension is difficult to control, so it is important to follow your treatment plan for accelerated hypertension precisely and to take all of your medications as instructed. Accelerated hypertension requires prompt treatment with medications to bring down your blood pressure to safe levels to prevent organ damage.

The goal of treatment is to reduce your blood pressure to lower the risk of accelerated hypertension. A number of different types of drugs can be used to treat high blood pressure including:

  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers
  • Central alpha agonists
  • Diuretics
  • Renin inhibitors
  • Vasodilators

What you can do to improve your accelerated hypertension

In addition to following your health care provider’s instructions and taking all medications as prescribed, you can improve your hypertension by:

  • Avoiding drugs that increase blood pressure
  • Eating a heart-healthy diet that includes potassium and fiber, and drinking plenty of water
  • Exercising at least 30 minutes a day
  • Limiting alcohol consumption to one drink a day for women, two a day for men
  • Limiting the amount of sodium (salt) you eat (less than 1,500 mg per day)
  • Maintaining a healthy body weight
  • Quitting smoking
  • Reducing stress

What are the complications of accelerated hypertension?

Organ failure, a possible complication of accelerated hypertension, is serious and life threatening. You can minimize your risk of serious complications by following the treatment plan you and your health care provider design specifically for you.

Accelerated hypertension that is left untreated can lead to hypertensive emergency and potential serious consequences including:

Even after successful medical management, patients with accelerated hypertension need ongoing follow-up care because they remain at higher risk of developing the above complications compared to other hypertensive adults.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 16
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Malignant hypertension. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001521/
  2. High Blood Pressure. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/
  3. Hegde S, Aeddula NR. Secondary Hypertension. [Updated 2020 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544305/