Discharge Instructions for Malignant Hypertension (Hypertensive Emergency or Urgency)

Malignant hypertension is very high blood pressure that causes harm to your organs. It is a medical emergency. There are 2 types:

Hypertensive emergency. This type is when you have dangerously high blood pressure that is harming organs in your body. The top number of a blood pressure reading is usually higher than 180 and/or a bottom number is higher than 120. You will also have symptoms that mean organs in your body are being harmed. This severe high blood pressure can cause damage to your heart, kidneys, brain, eyes, blood vessels, and other organs. See list of symptoms at the end of the page.

Hypertensive urgency. This type is when your blood pressure is 180/120 but you aren't having any symptoms that mean your organs are being affected. This should still be addressed. You will need to take steps to lower your blood pressure. You will need to take blood pressure medicine and make changes to your diet and exercise habits.

Below are instructions for how to manage your high blood pressure.

Taking your blood pressure

• Learn to take your own blood pressure. Be sure you know how to do it right. Your healthcare provider can give you detailed instructions. You can use an at-home blood pressure machine. Your provider can help you choose a reliable one. You must be sitting and resting for 5 minutes before taking your blood pressure.

• Keep a record of your blood pressure results. Ask your provider which readings mean you need medical attention.

• Have your blood pressure checked by your provider regularly.

• Hypertensive emergency. If you have a blood pressure reading at home that is higher than 180/120 and you have any symptoms shown at the end of this page, don't wait to see if it comes back down. Get emergency care right away.

• Hypertensive urgency. If you have a blood pressure reading at home that is higher than  180/120 wait 5 minutes and take it again. If the second reading shows either number at or above the first reading and you are not having any symptoms listed at the end of the page, contact your provider right way. You may need to change your medicines.

Taking medicines

• Take your blood pressure medicine exactly as your provider directed. 

• Learn the possible side effects of any prescribed medicines.

• Tell your provider about any medicine you are taking. Some medicines can cause malignant hypertension.

• Don't take medicines that contain heart stimulants. This includes some over-the-counter medicines. Check for warnings about high blood pressure on the label.

• Check with your provider before taking a decongestant. Some can make high blood pressure worse.

Lifestyle changes

• Limit your activity until your blood pressure is controlled.

• Cut back on salt.

  • Limit canned, dried, packaged, and fast foods.

  • Don’t add salt to your food at the table.

  • Season foods with herbs instead of salt when you cook.

  • Request foods at restaurants with no added salt.

• Keep a healthy weight. Get help to lose any extra pounds.

• Start an exercise program. Ask your provider how to get started. You can benefit from simple activities like walking, gardening, swimming, or dancing.

• Don’t drink more than 1 alcoholic drink a day for women and 2 a day for men.

• Limit drinks that contain caffeine to 2 per day. This includes coffee, cola, and black or green tea.

• Never take stimulants such as amphetamines or cocaine. These drugs can be deadly for someone with hypertension.

• If you smoke, get help to quit.

• Control your stress. Learn stress-management methods.

Follow-up care

Make follow-up appointments to see your provider regularly. At these visits, your provider will:

• Check your blood pressure

• Give you dietary advice

• Change your medicine as needed

Call 911

Call 911 if you have any of these:

• Chest pain or shortness of breath

• Seizure (with no history of seizure disorder)

• Back pain (upper or lower back)

• Moderate to severe headache

• Weakness in the muscles of your face, arms, or legs

• Trouble speaking

• Extreme drowsiness or confusion

• Restlessness, anxiety

• Fainting or dizziness

• Weakness, tingling, or numbness of your face, arms, or legs

• Change in vision (including blurred vision)

• Nausea or vomiting

• Blood pressure measured at home that is higher than 180/120