Hypertension: Hypertensive Crisis

What is it?

Hypertensive crisis is high, sudden, rapid, severe, inappropriate and symptomatic blood pressure in normotensive or hypertensive person. The target organs for hypertensive crisis are: eyes, kidneys, heart and brain.

Hypertensive crisis shows signs and symptoms of acute severe intensity with possible serious and rapid deterioration of target organs. There may be potentially life threatening and immediate, as the tension levels are very high, greater than 110 mmHg or diastolic blood pressure was minimal.

How to develop?

Blood pressure (BP) is equal to the blood volume (SV) from the heart sometimes peripheral resistance it encounters as it flows through our body (PA = SV x RP).
The volume of blood leaving the heart does not suffer major influences, except in special cases of organ failure or excess of circulating blood volume. Thus, the majority of cases of hypertension occurs by changing the peripheral resistance.
The sudden increase peripheral resistance is due to lack of regulatory neurodynamics mechanisms that regulate blood pressure.
The pathological conditions that act on the peripheral resistance may have several origins:
- neurological
- vascular
- drug
- drugs and
- excessive or inappropriate secretion of hormones

What does it feel?

Hypertensive crisis starts suddenly and the person may have:
- feeling of malaise
- anxiety and agitation
- severe headache
- dizziness
- blurring of vision
- chest pain
- cough and shortness of breath

The crisis is accompanied by signs and symptoms in other organs:
- In the kidney, there is hematuria, proteinuria, and edema.
- In the cardiovascular system, shortness of breath, chest pain, angina, myocardial infarction, arrhythmias and acute pulmonary edema.
- In the nervous system, ischemic stroke or hemorrhagic type, with seizures, impaired speech and movement.
- In the vision, blurring, bleeding and swelling of the fundus.

How is it diagnosed?

The normotensive or hypertensive patients presenting acutely the symptoms described above is questioned and examined by the doctor who checks the blood pressure levels and is very high, above 110 mmHg blood pressure low, with signs and symptoms of the hypertensive crisis and signs of rapid deterioration of various organs.

Often, patients are hypertensive pseudoseizures. These patients, although high levels of blood pressure have evidence rapid deterioration of the target organ and even life threatening. In a clinical review, they form a group of hypertensive patients who had their blood pressure by extra events, such as painful crises or emotional, immediate postoperative, panic or severe headaches. Are almost always ill-treated hypertensive or abandoned drugs. Such patients should not be confused with those who have a true hypertensive crisis.

Emergency

Major emergencies which may lead to hypertensive crisis are:
- hypertension associated with dissecting aortic aneurysm
- hypertensive encephalopathy
- stroke of any ischemic or hemorrhagic
- acute nephritis
- cardiac surgery, trauma, vascular, neurological or adrenal tumors
- crisis rebound by abrupt discontinuation of some antihypertensive drugs for continuous use (clonidine)
- in pregnancy complicated pre-eclamptic and eclamptic
excessive consumption of stimulants such as amphetamines, cocaine, drugs for colds that contain vasoconstrictors (decongestants)
- excessive use of steroids or increased production of adrenal tumors and exceptionally, in some cases, the use of contraceptives
- feocromocetoma
- by acute changes in renal vascular atherosclerotic patients with worsening hypertension

Treatment

Hypertension (HBP) accompanied by large and sudden increase in blood pressure requires that patients be protected from injury of target organs: eyes, kidneys, heart and brain.
The blood pressure should be immediately reduced with special oral and intravenous medications, used by physicians under strict control in intensive care units.

The hospital successfully prevents severe damage and irreversible damage that can lead the patient to death as acute myocardial infarction, acute pulmonary edema, hypertensive encephalopathy and ischemic strokes or serious bleeding.

Intervention should be the intensity corresponding to the severity of the crisis to avoid complications and to prevent hypertension becomes accelerated or "malignant."

There are some cases where the high blood pressure is not a hypertensive crisis and in this situation, the treatment can be done routinely by the physician.

However, the true hypertensive crisis requiring hospitalization, and immediate intensive care with medication and care, often the kind of potent vasodilators that decrease peripheral resistance changed greatly.

Questions you can ask your doctor

What is high blood pressure?
What level of my blood pressure?
Should I check my blood pressure at home?
What can happen to me if I do not treat high blood pressure?
What are the side effects of treatment?