Hypertensive crisis: causes, symptoms, treatment and complications

What is hypertensive crisis

Hypertensive crisis (HC) is a sudden and significant increase in the values of

The reasons for the rapid increase in pressure

Have to remember! The most common cause of development of hypertensive crisis is not adequately matched antihypertensive therapy, the absence of any, failure by the patient of medical recommendations for medication and other treatments.

Among the secondary reasons for the sharp increase in pressure include:

• self-modifying dose of medication;
• concomitant administration of drugs without medical supervision (especially the NSAID group);
• failure to follow dietary recommendations (consumption of high amounts of water and table salt);
• emotional nervous breakdown;
• the use of alcoholic beverages;
• meteorological changes (people with hypertension often suffer from weather sensitivity);
• fluctuations in the level of hormones in the blood, for example, during menstruation or menopause in women often occur hypertensive crises;
• with the abolition of some drugs, for example, withdrawal clonidine, beta-blockers;
• as a side effect of some medications and psychoactive substances (antidepressants, corticosteroids, metoclopramide, cyclosporine, drugs, etc.);
• intense physical activity;
• intense insolation;
• SARS;
• injury.

Video transmission of hypertensive crisis:

Classification of hypertensive crises

In medical literature you can find a lot of different classifications of hypertensive crises, but modern medicine only uses one, in accordance with which there are complicated and uncomplicated hypertensive crisis.

Uncomplicated hypertensive crisis

There is no evidence of acute pathology activities of the target organs. This GK is potentially dangerous for human life and there is a need in the rapid decline in pressure (a few hours).

For uncomplicated hypertensive crises include:

1. Brain (cerebral symptoms manifested is pain of head, vertigo, and other signs).
2. Cardiac (clinical picture is dominated by cardiac symptoms – cardialgia, shortness of breath).
3. Crisis with paroxysms hypothalamic origin (diencephalic autonomic symptoms – redness, vegetative-vascular symptoms, tremor, frequent urination).
4. Raising the GARDEN above 240 mm Hg. article and/or diastolic above 140 mm Hg. article that takes place completely without any pathological signs.
5. Significant increase in blood pressure after surgical intervention in people with severe burns.

Complicatedhypertensive crisis

In parallel with increase in blood pressure is noted by an acute disruption of the target organ, are a direct danger to human life, require immediate (within one hour) downward AD.

Complicated GC runs in the background:

1. Acute hypertensive

   Symptoms and diagnosis of hypertensive crises

   In this paragraph we will focus on the symptoms of uncomplicated hypertensive crises, as in complicated clinic takes on the character of the disease, which was complicated by the development of a crisis, and the increasing pressure departs on the second plan.

   The beginning of the crisis

   A characteristic feature of the GK is sudden onset (from a few minutes to a few hours). In some patients the increase in pressure develops suddenly, but the rest may experience symptoms-signs –

   Emergency care in uncomplicated hypertensive crisis

   Treatment of uncomplicated HC usually does not require intravenous administration of medications. The main route is oral antihypertensive medications quick action or intramuscular administration. Therapy of this condition can take place in an outpatient setting and does not require hospitalization of the patient in the hospital. But the mandatory control state of a person after 24 hours.

   Treatment should start immediately, have not yet developed complications, but the decline in pressure should be gradual (25% of the initial pressure for 2 hours, with subsequent achievement of normal blood pressure for several hours).

   For first aid use the following medications:

   • captopril – 12,5-50 mg orally or sublingually, the effect of the drug begins within 15-45 minutes;
   • nifedipine 10 to 20 mg orally or under the tongue and starts acting after 15 to 30 minutes;
   • amlodipine is 5-10 mg orally and through 6-120 minutes;
   • metoprolol – 50-100 mg orally, action is 20-30 minutes;
   • furosemide – 40-120 mg inside the action after 5-30 minutes;
   • clonidine is 0.075-0.3 mg inside the action after 30-60 minutes;
   • Dibazol – 4.8 ml/m, the effect after 10-15 minutes.

   Drugs from this group can make their own before the arrival of the ambulance. Ideally, each hypertensive should carry in his pocket one of these medicines for quick relief of crisis and prevention of its complications. In each case the choice of drug should take into account the individual contraindications to these medications.

   But, if the symptoms do not fit into the picture of uncomplicated crisis and you have suspicions on a particular complication, then self-treatment contraindicated.

   Video tutorial about urgent care in uncomplicated GC:

   A common complication of hypertensivecrisis

   Complicated GK is considered in the development of one of the following describes pathological conditions.

   Acute hypertensive encephalopathy (MSE)

   This is a specific complication of GK, which can occur swelling of the brain. OGE belong to the group of carry-over of circulatory disorders of brain tissue (stroke), but unlike other forms, for example, TIA, it is not accompanied by focal neurological symptoms.

   The basis for the development OGE is the breakdown of autoregulation of cerebral circulation. The fact that the blood vessels of the brain possess a special mechanism for the regulation of its clearance and tone, which provides a kind of autonomy and independence of the cerebral circulation from systemic arterial pressure. For example, in response to the increased pressure of cerebral vessels are narrowed, which prevents the flow of excess blood to the brain (hyperperfusion) and the resulting swelling of brain tissue, and in case of a fall of systemic pressure, cerebral vessels dilate, which ensures the supply of blood and prevention

   The sharp increase in pressure in pregnant women eclampsia

   Eclampsia is of GK in pregnant women is a complication of preeclampsia second half of pregnancy – preeclampsia. At its core is a form of acute hypertensive encephalopathy (which we have considered above), is associated with high blood pressure, seizures, impaired consciousness, acute renal failure. This is a very common cause of obstetric complications such as haemorrhage, premature detachment of the placenta, premature birth, fetal hypoxia and intrauterine death.

   Pressure reduction is the main treatment of eclampsia, but it is vital for mother and fetus. The goal of therapy is cessation of the convulsions, the resumption of placental blood flow, respiration of the mother.

   It must be remembered that to reduce the pressure below 140/90 mm Hg. article is impossible, as otherwise a decrease in the intensity of the fetoplacental blood flow and the development of acute fetal hypoxia.

   The drug of choice is magnesium sulfate. Additionally can be entered labetalol, clonidine, nitroglycerin, nifedipine, urapidil.

   Do not recommend the introduction of drugs from the group of ACE inhibitors, sartans, diuretics, nitroprusside.

   Making a conclusion it should be noted that a hypertensive crisis is a heterogeneous group of disorders and the only treatment tactics here. In each case, the patient should be seen by a specialist, which selects the appropriate drug to reduce the pressure, and decides on the need of hospitalization.