Hypertensive crisis - Causes, symptoms and treatment. MF.

A hypertensive crisis is a condition that occurs when the blood pressure rises sharply to large numbers, which is accompanied by a significant deterioration in the overall condition and, without decreasing pressure, can lead to severe irreversible consequences.

Hypertensive crisis is one of the most dangerous complications of arterial hypertension. It is established that only 20% of the population with diagnosed arterial hypertension receive treatment. Therefore, the external manifestations of hypertensive crises, as well as the basic principles of treatment should be known as patients suffering from increased blood pressure, and their relatives and friends.

Causes of development of hypertensive crises

Factors that can cause a hypertensive crisis can be divided into external and internal ones.
External factors include:

1. Great physical load, especially among untrained individuals.
2. Stressful situation.
3. Weather change in meteosensitive persons.4. Excessive consumption of salty foods.

5. Alcohol abuse
6. The use of hormone-containing drugs for the purpose of contraception.
7. Sudden failure to take medications that lower blood pressure.

Internal factors include:

1. Changes in the hormonal background in women during menopause.
2. Development of complications of ischemic heart disease( acute coronary syndrome, attack of cardiac asthma).
3. Disruption of the normal urine flow in prostatic adenoma.
4. Severe impairment of blood supply to the kidneys( including secondary aldosteronism).
5. Obstructive sleep apnea-hypopnea syndrome.

Special attention should be paid to the so-called iatrogenic hypertensive crises, that is, drug-related crises:

- Hypertensive crises can occur when drugs are withdrawn to lower blood pressure( clonidine, beta-blockers).
- Sudden increase in blood pressure may result from side effects of some drugs( nonsteroidal anti-inflammatory drugs, glucocorticosteroids).
- It is also possible the development of hypertensive crises on the background of taking several drugs due to their interaction.

Hypertensive crises associated with drugs are usually accompanied by severe clinical symptoms and difficult to treat.

Possible symptoms in the hypertensive crisis

The hypertensive crisis is characterized by a sharp onset, increased blood pressure to high figures( individual for each) and disruptions in the work of vital organs. The defeat of organs with hypertensive crisis is associated, as a rule, with a violation of their nutrition.

With the development of the hypertensive crisis, the following external signs are possible.

• In case of damage to the nervous system : severe headache, dizziness, nausea, vomiting, blurred vision, flickering before the eyes, numbness of the hands, face, lips, tongue, hand or foot movement( maximum duration up to 24 hours), there may be a short loss of vision or the appearance of seizures. At the time of increased blood pressure, chills, fear, excessive sweating, irritability, thirst may occur. At the end of the crisis, with a drop in blood pressure, many patients report a large amount of light urine.
• When the heart is affected : pain in the heart, palpitation, heart failure.

Diagnosis of the hypertensive crisis

The diagnosis of the hypertensive crisis is based on the above complaints that arise when the blood pressure rises. In this case, it should be borne in mind that the figures of blood pressure - this is an individual indicator for each patient. Very often, hypertensive crises with characteristic clinical symptoms develop at arterial pressure of 150/110-160 / 120 mm Hg, especially in people with the usual low or normal blood pressure.

To determine the lesion of vital organs, it may be necessary: ​​

• echocardiography( ultrasound of the heart), electrocardiography.
• chest radiography.
• Ophthalmoscopy( examination of the internal structures of the eye).
• general urine analysis, determination of the glomerular filtration rate and the level of creatinine, urea and potassium in the blood.
• consultation of a cardiologist, neurologist, ophthalmologist, nephrologist.

Treatment of hypertensive crisis

Hypertensive crisis is a serious disease, which under certain conditions can lead to death. Therefore, his treatment should be intensive and timely.

If there are signs of complications( acute myocardial infarction, acute left ventricular failure, acute retinopathy, stroke) it is necessary to call an ambulance as soon as possible. Before the arrival of specialists it is recommended to take a horizontal position, to try to calm down. The use of therapeutic drugs to reduce blood pressure is self-contraindicated, as this can aggravate the course of the disease. In this case, hospitalization in a hospital with intensive care, as a rule, with intravenous administration of drugs is recommended.

In other cases, blood pressure should not decrease so quickly. It is possible to use short-acting tablets. A patient suffering from hypertension should be potentially ready to develop a crisis, and discuss with the doctor the possibility of using certain medications that should always be at hand. As a rule, the use of such drugs as nifedipine and captopril is indicated as first aid for the treatment of hypertensive crises. For an early absorption into the blood, it is recommended not to swallow the pill, but put under the tongue until complete dissolution. In some cases, a good effect can be expected from taking diuretic drugs( furosemide).

When hypertensive crisis in the first two hours is not recommended to reduce blood pressure by more than 25% of the original figures. In the next six hours, it is necessary to lower blood pressure to 160/100 mm Hg. The next day it is recommended to consult a therapist or cardiologist to correct the tactics of treating hypertension. If within 1-2 hours it is not possible to achieve a reduction in pressure by short-acting tablets, then it is recommended to call an ambulance and hospitalization in a hospital.

Possible complications of hypertensive crisis:

1) from the heart and large vessels: acute myocardial infarction, acute left ventricular failure, acute aortic dissection with a rupture or without aortic rupture;
2) from the brain: acute encephalopathy, stroke, transient ischemic attack;
3) from the kidneys: acute renal failure
4) from the side of the eye: acute retinopathy with hemorrhages in the retina.

Prognosis for hypertensive crisis

The prognosis of hypertensive disease during the development of crises is always serious. And only timely effective correction of treatment can prevent the development of serious consequences associated with the crisis. In the event that the hypertensive crisis occurs with one or another complication, the prognosis depends on the type and severity of the complication.

Prevention of hypertensive crisis

• constantly monitor blood pressure and tell the doctor about any abnormalities;
• regularly take medications to lower blood pressure, recommended by your doctor.
• Do not abuse salt foods and alcohol.
• keep track of your weight.
• quit smoking or reduce the number of cigarettes smoked.
• Avoid stressful situations.
• do not forget about regular physical activity.

Doctor therapist Sirotkina EV