Malignant Hypertension In patients with malignant hypertension, the elevated blood pressure leads to fibrinoid necrosis of the small vessels of the kidney; this, in turn, stimulates excessive renin release and thus further exacerbates the hypertension by activation of the renin-angiotensin-aldosterone system. Such patients therefore have secondary hyperaldosteronism (Fig. 10.10). See also: • Conn's Syndrome