MALIGNANT HYPERTENSION

Hypertension Center
Although rare, malignant hypertension is the most ominous form of high blood pressure. It's marked by an unusually sudden rise in blood pressure to dangerous levels, often with the diastolic reading reaching 130 mm Hg or higher. However, it may also occur at lower, seemingly more normal blood pressure levels if the rise is particularly abrupt. Unlike other kinds of hypertension, it's usually accompanied by dramatic symptoms such as severe headache, shortness of breath, chest pain, nausea and vomiting, blurred vision or even blindness, seizures, and loss of consciousness.
Malignant hypertension is a medical emergency. It places people at immediate risk for heart attack, stroke, heart failure, permanent kidney damage, and bleeding in the brain. Anyone who develops the condition must be hospitalized immediately.

Malignant hypertension develops in less than 1 percent of people who already have high blood pressure. In rare cases, the appearance of malignant hypertension is the first sign that a person has high blood pressure. While the cause of this condition is unknown, you should never stop taking antihypertensives without your doctor's supervision. Doing so might cause a precipitous increase in your blood pressure.

Types of Hypertension
Medications That Can Cause Hypertension
Some drugs can cause a spike in blood pressure.
Many drugs, including some over-the-counter preparations, can elevate blood pressure (see "Drugs That Can Raise Blood Pressure," below). Certain medications prescribed for autoimmune diseases — such as glucocorticoids (also called corticosteroids), cyclosporine, and tacrolimus — constrict blood vessels throughout the body, as do some cancer-treating agents. Hypertension may also be a side effect of nasal decongestants, anabolic steroids, or MAO inhibitors (a class of antidepressants), as well as nonsteroidal anti-inflammatory drugs, or NSAIDs (Advil, Aleve). Rofecoxib (Vioxx), a COX-2 inhibitor, also causes hypertension, but this drug was withdrawn from the market because of concerns that it increased the risk of heart attack and stroke. In addition, NSAIDs and possibly some COX-2 inhibitors can cause kidney dysfunction, and in some cases cardiovascular effects, so discuss your personal health risks with your doctor when considering the regular use of these medications.
The decongestants found in most over-the-counter cold, flu, and allergy medicines and many weight loss supplements may elevate blood pressure and interfere with medications used to treat hypertension. Fortunately, some cold, cough, and flu remedies are specially formulated for people with high blood pressure. However, if you are taking a medication for hypertension, it's always a good idea to talk to your doctor before taking any over-the-counter medications.

Shortly after birth control pills came on the market in the 1960s, researchers discovered they could raise blood pressure, sometimes to dangerously high levels. As a result, they were found to increase a woman's risk of having a stroke, particularly among smokers. However, these early oral contraceptives contained considerably higher doses of estrogen and progesterone than current formulations do. Today, it's much less common for oral contraceptives to cause hypertension, and when it does occur, it's usually among women who smoke, are obese, or are over 35. In these cases, blood pressure usually returns to normal after the woman stops taking the pill.

The ingestion of lead or cadmium can also cause hypertension.

Drugs that can raise blood pressure

Prescription drugs

anabolic steroids
bromocriptine
cyclosporine
disulfiram
ergotamine
erythropoietin
estrogens
glucocorticoids or corticosteroids (such as prednisone)
lithium
MAO inhibitors
tacrolimus
tricyclic antidepressants
Over-the-counter drugs
nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, indomethacin, naproxen
phenylephrine (found in nasal sprays)
sympathomimetic drugs, a broad category that includes any medications that stimulate the central nervous system and widen blood vessels; such drugs are found in some decongestant, allergy, and asthma medications.

Hypertension Center

White-Coat Hypertension
Stress can elevate blood pressure. For this reason, some people whose blood pressure is usually normal can become hypertensive in the doctor's office. This phenomenon is dubbed white-coat hypertension. In the past, doctors often dismissed these elevated readings as a reflection of the temporary anxiety many people experience at the clinic or hospital. But now some experts think white-coat hypertension is worth investigating because it might shed light on how stress influences blood pressure.
People who are habitually affected by stress — whether from losing a job, feeling pressure at work, or simply getting stuck in traffic — may develop temporary or longer-lasting hypertension that could inflict some of the same damage as full-time hypertension. By figuring out how these people's blood pressure varies throughout the day, doctors can determine how best to treat them — if at all.

To get this information, patients take a portable device home with them and check their blood pressure periodically over the course of a week or two. Another option is a blood pressure monitor and cuff that you wear for 24 hours. The device automatically takes a blood pressure reading every 15–30 minutes while you go about your daily activities. This technology may not be covered by insurers, although a Medicare advisory committee recommended in 2001 that Medicare pay for such monitoring for people who are believed to have white-coat hypertension (see "Monitoring Blood Pressure at Home").

Labile Hypertension
Labile means ever-changing, and in labile hypertension, blood pressure fluctuates far more than usual. Your blood pressure might soar from 119/76 mm Hg at 10 a.m. to 170/104 mm Hg at 4 p.m. These fluctuations can spring from a variety of sources, such as too much caffeine, anxiety attacks, or stress overload. Whatever the cause, these transient episodes of hypertension can be dangerous and should be treated. As with white-coat hypertension, home blood pressure monitoring over a 24-hour period helps determine the best treatment strategy (see "Monitoring Blood Pressure at Home"). You're most likely to experience labile hypertension when you are in transition from normal to high blood pressure. Its duration can range from a few weeks to many years.

Resistant Hypertension
Hypertension is often treated by adopting healthier habits and taking drugs to lower blood pressure, called antihypertensives. The first drug prescribed, however, doesn't always work. Your doctor may have to increase the dose, prescribe an additional drug, or substitute a different drug. Sometimes, though, your blood pressure remains persistently elevated in spite of these efforts.
In some instances, resistant hypertension results from drug interactions. For example, antihypertensive drugs may lose their effectiveness if you're also taking certain antidepressants or even some over-the-counter drugs, such as pain relievers, cold preparations, and diet aids. Use of caffeine, excessive alcohol, or too much licorice (either as candy or as found in some chewing tobaccos) can also contribute to persistently high blood pressure. Other causes include panic attacks, chronic pain, sleep apnea, fluid retention, kidney damage, weight gain, and inflammatory artery disease (arteritis).

Give your doctor as much information as possible about the medications you take, the foods and drinks you consume, and any conditions you may have. There are often simple ways to avoid the interactions that render blood pressure medications ineffective.

Resistant Hypertension
Hypertension is often treated by adopting healthier habits and taking drugs to lower blood pressure, called antihypertensives. The first drug prescribed, however, doesn't always work. Your doctor may have to increase the dose, prescribe an additional drug, or substitute a different drug. Sometimes, though, your blood pressure remains persistently elevated in spite of these efforts.
In some instances, resistant hypertension results from drug interactions. For example, antihypertensive drugs may lose their effectiveness if you're also taking certain antidepressants or even some over-the-counter drugs, such as pain relievers, cold preparations, and diet aids. Use of caffeine, excessive alcohol, or too much licorice (either as candy or as found in some chewing tobaccos) can also contribute to persistently high blood pressure. Other causes include panic attacks, chronic pain, sleep apnea, fluid retention, kidney damage, weight gain, and inflammatory artery disease (arteritis).

Give your doctor as much information as possible about the medications you take, the foods and drinks you consume, and any conditions you may have. There are often simple ways to avoid the interactions that render blood pressure medications ineffective.