Discharge Instructions for Malignant Hypertension (Hypertensive Emergency or Severe Hypertension)

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

Hypertensive emergency. 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 or the bottom number is higher than 120, or both. You have symptoms that mean organs in your body are being harmed. This level of high blood pressure can damage your heart, kidneys, brain, eyes, blood vessels, and other organs.

Severe hypertension. 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'll need to take steps to lower your blood pressure. This will include taking blood pressure medicine and making changes to your diet and exercise habits.

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

• Learn to take your own blood pressure. Be sure you know how to do it right. Your doctor can give you detailed instructions. You can use an at-home blood pressure machine. Your doctor 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 doctor which readings mean you need medical attention.
• Have your blood pressure checked by your doctor 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.
• Severe hypertension. If you have a blood pressure reading at home that is higher than 180/120 and don't have any symptoms, wait 1 to 2 minutes and take it again. If the second reading shows either number at or above the first reading and you are still not having any symptoms listed at the end of the page, contact your doctor right way. You may need to change your medicines.

• Take your blood pressure medicine exactly as your doctor directed.
• Learn the possible side effects of any prescribed medicines.
• Tell your doctor 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 doctor before taking a decongestant. Some can make high blood pressure worse.

• 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.
• Stay at a weight that is healthy for you. Talk to your doctor if you need help losing weight.
• Start an exercise program. Ask your doctor how to get started. You can benefit from simple activities like walking, gardening, swimming, or dancing.
• For people with very high blood pressure, it's best to avoid alcohol completely. If you do drink, limit the amount.
• Limit drinks that contain caffeine to 2 a day. This includes coffee, cola, and black or green tea. If your blood pressure is not yet controlled, have no more than 1 drink with caffeine a day.
• Never take stimulants, such as amphetamines or cocaine. These drugs can be deadly for someone who has hypertension.
• Don’t smoke, vape, or use other tobacco or nicotine products. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Control your stress. Learn stress-management methods.
• Get at least 7 to 8 hours of sleep every day.

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

• Check your blood pressure.
• Give you dietary advice.
• Change your medicine as needed.

Call 911 if you have any of these symptoms:

• 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 or 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, with any symptoms