Symptoms of Malignant Hypertension

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In malignant hypertension (MHT), symptoms are caused by a very high spike in blood pressure that damages one or more organs, including the brain, heart, kidneys, and blood vessels. Its symptoms range from headache to low urine output to chest pain to vision changes.

Malignant hypertension can result in heart attack, aortic dissection, stroke, or seizure. Black people, smokers, pregnant people, and people who use drugs such as cocaine and amphetamines are among those at the highest risk of developing MHT.

This article will describe the common and rare symptoms of malignant hypertension, its complications, how it affects different groups, and when to see a healthcare provider.

Person grabbing chest and gasping for breath

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Common Symptoms

The symptoms of malignant hypertension are nonspecific, meaning they mimic other medical conditions, making it hard to diagnose. Timely diagnosis and treatment are key to preventing serious organ damage and death.

If you have high blood pressure, the following signs and symptoms may indicate malignant hypertension:

  • Headache
  • Changes in vision, including blurred vision or double vision (diplopia)
  • Shortness of breath
  • Change in mental status, which can include stupor (impaired responsiveness, being difficult to arouse), agitation, anxiety, confusion, reduced alertness, decreased ability to concentrate, fatigue, restlessness, or sleepiness
  • Chest pain, such as a crushing or pressure sensation.
  • Back pain
  • Cough
  • Nausea or vomiting
  • Reduced urine output
  • Seizure (disruption of electrical activity in the brain)

Rare Symptoms and Complications

Malignant hypertension is relatively rare, occurring in less than 1% of people with hypertension, but if left untreated, malignant hypertension can lead to severe medical complications, repeated hospitalizations, and even death.

The following conditions may develop if malignant hypertension treatment is delayed:

  • Permanent heart damage, such as a heart attack (a blockage of blood flow to the heart muscle), aortic dissection (a tear in the wall of this major blood vessel), chest pain (angina), and abnormal heartbeat (arrhythmia)
  • Stroke (a blockage of blood flow or bleeding in the brain), characterized by symptoms such as numbness or weakness of the arms, legs, or face, or difficulty with word finding
  • Blood in the urine (hematuria) due to kidney damage or kidney failure, which commonly presents as reddish or pink urine
  • Permanent blindness
  • Severe headache and subtle changes in personality due to swelling of the brain (encephalopathy)
  • Pulmonary edema (fluid in lungs)

Subgroup Indications

Malignant hypertension generally affects younger adults, with one study reporting an all‐cause mortality of 10% at five years in patients with a mean age of 44 years. High-risk groups for malignant hypertension include:

  • Black Americans: One major study found that those who self-identify as African, African American, and Afro-Caribbean were nearly 4 times more likely to develop malignant hypertension than their White counterparts (an annual incidence rate of around 2 per 100,000 for White populations vs. 7.3 new cases per 100,000 for Black populations)
  • Smokers (current and former smokers)
  • People with a history of kidney failure
  • Pregnant people
  • Recreational drug users, especially of cocaine and amphetamines

In a pregnant person, malignant hypertension (hypertensive emergency) is dangerous for both the pregnant person and the fetus. Hypertension may be preexisting before pregnancy or develop during pregnancy. It can have no symptoms. Severe hypertension is more likely to develop after 20 weeks of gestation.

When to See a Healthcare Professional/Go to the Hospital

Malignant hypertension is a medical emergency that requires immediate care at a hospital.

If you have hypertension and experience vision changes, shortness of breath, chest pain, weakness in your arms or legs, difficulty finding words, or any changes in mental status like confusion or difficulty concentrating, you may be having a heart attack or stroke and should seek immediate medical care.


Malignant hypertension affects multiple organ systems, including the brain, heart, kidneys, and blood vessels. A person with malignant hypertension may have symptoms of this damage, such as headache, vision changes, chest pain, a change in mental status, or reduced urination.

Symptoms are often associated with the conditions that malignant hypertension can cause, such as heart attack, aortic dissection, stroke, or seizure. Malignant hypertension is a medical emergency that needs immediate attention at a hospital.

A Word From Verywell

If you have high blood pressure, it is essential to have it treated, never skipping your blood pressure medications. Preventing high blood pressure can lower your risk of malignant hypertension.

A heart-healthy lifestyle that includes maintaining a healthy weight, eating a diet low in salt and saturated fats, engaging in regular exercise, and getting seven to eight hours of sleep can lower your risk of hypertension.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Mount Sinai. Malignant hypertension.

  3. Amraoui F, Van Der Hoeven NV, Van Valkengoed IGM, Vogt L, Van Den Born B‐J. Mortality and cardiovascular risk in patients with a history of malignant hypertension: a case‐control study. J Clin Hypertens (Greenwich). 2014;16:122–126. doi:10.1111/jch.12243

  4. Prestige ER. Malignant hypertension - causes, symptoms, complications.

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  6. American Heart Association. Hypertensive crisis: when you should call 911 for high blood pressure.

By Shamard Charles, MD, MPH
Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.