Malignant And Renal Vascular Hypertension

The Differences Between Malignant Hypertension and Hypertension

This is a subject very near and dear to my heart - literally! I have never had hypertension (high blood pressure) in my entire life, even during pregnancies and suddenly this past summer, I found myself faced with the horrifying diagnosis of not only hypertension but malignant hypertension.

Malignant hypertension is high blood pressure that basically comes from out of nowhere and is extremely high (systolics of 130 or greater). There can be heralding symptoms, however, in my case, by the time I was aware of my blood pressure numbers, they were far beyond 'a little elevated'.

The most horrifying aspect of this ordeal to me was that I did not realize that I had become hypertensive until it was a crisis, and secondly, I did not receive proper medical treatment at the outset. Please read and be aware of this medical condition as it can cost you your kidney health if not your life by going untreated.

Malignant Hypertension Symptoms

The only hallmark symptom that I can truly say I had at the outset of this illness that spanned over a month before it got resolved was overwhelming fatigue. Since I am a high energy kind of person, that in itself was a bit distressing. However, finally, I ended up with severe abdominal pains which happened to me on 2 separate occasions and thinking I had appendicitis, I went to the emergency room the second time. However, even at the ER, my blood pressure was not noted to be markedly elevated.

On going to my physician for the usual followup after an ER visit, my blood pressure was 180/130, much to my surprise, and my kidney functions and potassium were also off. Since I had never had a history of any of this, it was quite alarming. Even though I was 55 years old, to come on so suddenly was quite unnerving. I also by then had developed a horrible headache which I was unable to shake and the fatigue was rearing its head constantly.

Since I usually have LOW blood pressures, I was not a tad bit alarmed. My provider, who I thought was a very reputable physician assistant, proceeded to diagnose my hypertension as simple hypertension and she made the erroneous assumption that this was due to stress. When I pressed her about how absurd that was in connection with this particular patient, she basically brushed any other possibility aside. She gave me samples of medications, told me to quit being so stressed, and let me walk out of the office with a blood pressure that should have been medically treated urgently.

To shorten a very long and exasperating story, I spent the next week being flipped and flopped from one ineffective medication to another, all of which I reacted to with worsening headaches, incredibly high blood pressures and overwhelming fatigue. Now if I wasn't stressed before, this definitely was doing it! As well, I had the added benefit of leg swelling to enormous proportions - still being told that I was too stressed and that was the cause of all of this.

By profession, I am a medical transcriptionist, and since I know symptoms, I broached the subject one afternoon to her that perhaps this was being caused by 'something else' such as renal vascular hypertension only to get my words thrown back in my face on the order of 'don't you think you are jumping the gun here a bit?'

At the end of that week of agony, I finally ended up in the ER because I had a headache that was totally out of control. I could not work, I could not sleep, and I was definitely beyond 'stressed'. My blood pressure was STILL sky high as well after all these medications but they sent me home after administering pain medication and giving me more to take so that I was knocked out.

'Enough is enough' could not have been truer. I finally decided that if I did not get help and get it soon, I would be in serious medical shape so I took it upon myself to get myself to an internal medicine physician.  The end of the story is that after many tests, it was discovered that in fact I did not have hypertension related to stress and that I had been misdiagnosed as well as mistreated.

The term 'malignant hypertension' means that this is a sudden, rapid development and results in extremely high blood pressures. This affects about 1% of people with hypertension but it is something that is a medical emergency. Although I did not have many of these symptoms, I did have some of them but was feeling so poorly that I did not realize what I had.

  • Chest pain, mid chest or crushing/pressure (this can lead to a heart attack)
  • Cough
  • Headache (this finally did develop - it was the worst of my life and unrelenting)
  • Blurred vision
  • Abnormal sensation or numbness - arms, legs, face or other areas
  • Changes in mental status such as restlessness, anxiety, decreased alertness or ability to concentrate, sleepiness, confusion and fatigue (I had the overwhelming fatigue and sleepiness for no explainable reason)
  • Decreased urine output (this is an indication of kidney damage)
  • Nausea or vomiting
  • Seizure
  • Shortness of breath
  • Weakness of arms, legs, face or other areas

The other symptom that I had in spades was that when I had the headache, it was so severe that it would wake me from sleep and if I got up out of bed, it would disappear or lessen for a time, usually 20 or 30 minutes later.  This is an indicator of malignant hypertensive headache.

Complications of Untreated Malignant Hypertension

  1. Brain damage from coma
  2. Seizures
  3. Mentation changes (encephalopathy)
  4. Intracerebral hemorrhage (bleed on the brain)
  5. Constriction or spasming of the arteries in the brain
  6. Stroke
  7. Swelling
  8. Heart attack
  9. Chest pain due to weakened heart muscle
  10. Abnormal rhythm of the heart
  11. Kidney failure
  12. Lung edema which in turn can lead to congestive heart failure
  13. Permanent blindness

Again, if you suspect you have the malignant variety of hypertension or even if your blood pressure is abnormally elevated, seek medical attention immediately as it is better to be safe than sorry.

We have invested in a simple blood pressure cuff as well so that periodically we can monitor our own blood pressures on a weekly basis - in the event of high values on a more frequent basis. For the price of the monitor, it has been well worth it so that I will never be caught unaware again.

For renal vascular hypertension, the key is to keep those scheduled checkups for performance of labs and/or any imaging studies that need to be done and monitoring your blood pressure on a regular basis and keeping track of the numbers.

Diagnosis of Renal Vascular Hypertension

As a result of the malignant hypertension and after having numerous blood tests, it was recommended that I have an MRI of my kidneys and also an MR angiogram of my renal arteries to see if this was the culprit causing the spikes in blood pressure. Sure enough, that was my doctor's #1 theory and it proved to be true. I had greater than 50% narrowing of not one renal artery but both renal arteries, which again, can cause malignant hypertension. If untreated, this condition can also cause kidney death because it means your kidneys are receiving decreased circulation and eventually stop functioning.

Fortunately for me, I discovered the inappropriateness of the treatment that I was receiving early on. I can only be thankful that I reacted to all the medications my PA-C had given me because if the hypertension had just 'settled down' nothing ever would have been discovered until it was perhaps too late and irreparable damage could have been done. By finding the cause of the hypertension, I was scheduled right away and had balloon angioplasties of both renal arteries which opened them up instantly though it does take some time for normal flow to be restored.

What causes this? According to the literature, renal vascular hypertension is most often caused by fibromuscular dysplasia, which is usually a genetic condition. In women, unfortunately it is almost always bilateral. In men, it usually occurs to one side or the other. It also is much more frequent in women than in men. It also can be caused by high cholesterol which then affects your arteries.  In my case, since my cholesterol is normal, it was not caused by cholesterol plaque but instead by this entity of fibromuscular dysplasia.

My distress, however, comes in knowing the millions of people in this country who are diagnosed with hypertension every day and the multitude of medications that are thrown at all of us. I'm wondering how many providers take the time to rule out renal vascular hypertension or fibromuscular dysplasia.

Had the angioplasty and ballooning not worked on my kidney arteries, I would have had to have stents placed in the arteries to keep them open to blood flow. I feel so very fortunate that I caught this in time and that by all appearances no serious damage was done. I have been able to also wean down my blood pressure medicine to the smallest possible dose and may be able to be off it completely within the next month or so. However, I will have to be checked now every 3 months throughout my lifetime to make sure that the blood flow is still appropriate and that my kidney functions are normal. I say though - a very small price to pay for one's health!

Tests To Diagnose Renal Vascular Hypertension

If you have any worries about the possibility of malignant hypertension or renal vascular hypertension as a cause for high blood pressure, these are some of the tests that can be performed to diagnose it.

  • Blood test of BUN and creatinine - mine were abnormal
  • Arterial blood gas
  • Urinalysis (casts in the urine show kidney damage)
  • Chest x-ray can show an enlarged heart or congestion
  • Blood test of aldosterone (mine was abnormal)
  • Cardiac enzymes (these are markers for heart damage)
  • Blood test for renin (mine was abnormal)
  • Electrocardiogram
  • Renal ultrasound though the standard now is for an MRI or MR angiogram of the kidneys

 

Malignant Hypertension Video

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Comments 13 comments

Ernest de Cugnac 4 years ago

Valuable and important article - thanks for posting it. It allowed me to have a much more informed conversation with my doctor than would otherwise have been possible.


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akirchner 5 years ago from Central Oregon Author

Thanks for the read IMChemist...I think having it made it that more 'real' for me and thought I'd best write about it!


ImChemist profile image

ImChemist 5 years ago

Wow , this hub is very informative.


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akirchner 5 years ago from Central Oregon Author

Thanks, Dr. Chad - the whole experience was very informative for me and I guess I'm glad I experienced it as I had no idea!


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DrChad 5 years ago from USA

I really admire you for nicely sharing your information with us. I find your hub very informative. Thanks.


akirchner profile image

akirchner 6 years ago from Central Oregon Author

Gracenotes thanks so much for the comment - it really did start to bug me totally that she would not listen to me because I know 'stuff' and she just dismissed what I knew. Always a learning curve and just glad I took care of myself - which really is the basis of good medicine. You have to be proactive in your own health and I'm just glad I was able to solve the mystery!


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gracenotes 6 years ago from North Texas

It does help enormously, just in terms of awareness, to have worked in some area of medicine, and thereby, help yourself make treatment decisions. You are a medical transcriptionist, and I was a medical librarian for many years. Also, if I had something happen to me like you did, I would be on the phone to my brother-in-law, the internist. If he didn't take it seriously, my sister would, and she would start trying to get to the bottom of this (she used to be a medical records administrator. :-) ) Also, I've got a niece in her second year of medical school, so I do feel blessed that help and advice are available in my family!


akirchner profile image

akirchner 6 years ago from Central Oregon Author

Definitely! I have always been the proverbial healthy as a horse and this really rocked my world especially since the provider I had was so NOT up on the info. But I work in medicine and know that we can only be our own advocates on all fronts. Good luck to you with yours...and thanks so much for tagging me - it is nice to know about other folks and what they have so we can hopefully make strides to figure the whole darn thing out. I have a legally blind son who suffers from birth defects -he is 31 years old - and I know from personal experience how slowly the wheels of change seem to revolve. The more of us who are aware though - the better. Thanks so much for your input - and take care of you....Audrey


Roxy1013 6 years ago

As a multi-site FMD patient, first diagnosed in 2004, I thank you for sharing your story. Even with the balloon angio's, I continue to have episodic malignant hypertension. Keep up with those follow up appointments! As many of us FMD'ers know, this disease demands that you be your own advocate! Kudos to your commitment.


akirchner profile image

akirchner 6 years ago from Central Oregon Author

Exactly - I get upset when I think about how awful I felt and how I was just 'giving up' and not listening to myself because my body was not cooperating. I am just so glad I got fed up and checked something else out. Normally I am the strongest advocate about participating in your own health care but it goes to show when you get 'sick' you forget what you are supposed to do. Luckily I had Bob too and between the 2 of us, we decided proactively to seek a second opinion! Thanks for stopping by.....Audrey


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BkCreative 6 years ago from Brooklyn, New York City

Thanks for sharing this information - complete with all the symptoms and walking us through your personal experience!

I am so glad that you stayed vigilant and took responsibility for finding solutions - this is something we all must learn to do. This could have been yet another one of those horror stories - another 'oops' - glad it is working out for you.

Whew!


akirchner profile image

akirchner 6 years ago from Central Oregon Author

Oh please do! I think that it is going to turn out to be one of those oops in medicine that they are not paying attention to. I am healthy as the proverbial horse and it just floored me to have something wrong and so out of the blue - but then insult to injury when she did not listen to me....but just so glad I got it fixed! At least for now and it was relatively simple after they just figured out what was wrong. Glad to be of 'service' and keep me posted if you find out anything. Audrey


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alekhouse 6 years ago from Louisville, Kentucky

Wow! So sorry you had to go through all of this, but glad you finally found out the cause and were able to have it treated. I have been diagnosed with hypertension, but it seems to have gone away. I do wake up with headaches that subside after I'm up for 20 minutes or so. I will probably mention this to my doctor next time I see him. Thanks for such an informative hub.

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