Internal Medicine

High blood pressure crisis

Synonyms in a broader sense

Hypertensive Crisis, High Blood Pressure Emergency, Hypertensive Emergency

definition

The acute increase in blood pressure to values of over 230/130 mmHg is sign of hypertensive crisis / high blood pressure crisis. If there are symptoms in the course of the increase in blood pressure, the heart or Nervous system concern, one speaks of a hypertensive emergency.

The hypertensive crisis does not pose an immediate threat to life, but it can turn into a hypertensive emergency and then because of the life-threatening complications it becomes an absolute emergency that must be treated in a clinic.

Any form of increased blood pressure can lead to a derailment, but this acute event occurs most frequently with advanced dysfunction of the Kidneys and in patients with Pheochromocytoma, a hormone-producing tumor.

Symptoms of acute rise in blood pressure

The patients with acute high blood pressure events often complain of pain in the chest area (Angina pectoris), Palpitations (Cardiac arrhythmias) and shortness of breath (dyspnoea). You are unable to cope with stress and feel acutely ill. The massive rise in blood pressure can lead to headaches, vomiting, blurred vision, confusion, and neurological disorders Epistaxis (especially nosebleeds with headaches).

Cause of the rise in blood pressure

Most often, acute blood pressure derailment occurs as a complication in severe renal hypertension, i.e. an increase in blood pressure due to kidney disease or endocrine hypertension, i.e. if you have high blood pressure due to hormonal changes.

The acute increase in blood pressure can also arise on the basis of primary hypertension if the high-pressure patient e.g. is under great tension and stress. Primary hypertension is a form of blood pressure in which no organic cause for the increased blood pressure can be found, rather the high blood pressure is the result of various trigger factors. So one cannot find any organ disease as the reason for the high blood pressure.

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Likewise, derailments of the values are possible if a drug therapy to lower blood pressure is abruptly ended or interrupted.

A blood pressure crisis can also occur during pregnancy, which is known as eclampsia. Read more about the topic here: Lowering blood pressure during pregnancy

Consequences of a blood pressure derailment

The brain and kidneys can be damaged in a high blood pressure crisis. The vessels of the brain expand when there is an acute increase in blood pressure, causing fluid to pass from the vessels into the surrounding tissue and a Brain swelling (Cerebral edema). Besides, it can too Cerebral hemorrhage come.

In the kidney, the massively high blood pressure values cause tissue destruction and the formation of blood clots in the kidney vessels. The organ is massively damaged, resulting in an acute restriction of the filter function of the kidneys, which is known as acute kidney failure designated.

The acute organ failure must be remedied as quickly as possible in order to prevent further and lasting damage.

That too heart can be harmed by a high blood pressure crisis:
There is acute stress on the left heart, as it has to pump against a greatly increased blood pressure. If the heart cannot pump a sufficient amount of blood into the vascular system against this pressure, it is called left heart failure. It can also cause chest pain and an impending one Heart attack come.

Therapy of high blood pressure crisis and hypertensive emergency

A careful and fast medical procedure with the aim of keeping organ damage as low as possible is necessary for the care of a patient with an acute increase in blood pressure.

The choice of medication is based on the patient's previous illnesses and on which organs are affected by the acute rise in blood pressure. The therapy of the two forms of derailment differs, therefore the respective procedure is described one after the other.

Therapy of hypertensive crisis

The therapy of the hypertensive crisis, in which, by definition, there is no organ damage or functional impairment, the patient's blood pressure should be lowered slowly and in a controlled manner to normal high values in the following 24 hours. Lowering blood pressure too quickly could lead to a reflex increase in blood pressure; to avoid this, the drugs are given orally, i.e. the patient is given medication to swallow. As a rule, hospitalization is not necessary for the treatment of the hypertensive crisis.

Therapy of hypertensive emergency

The hypertensive emergency is a life-threatening emergency situation that requires rapid action. The focus of the therapy is a rapid but controlled lowering of blood pressure by means of drugs that are given directly into the bloodstream via a venous access, which in this way act the fastest. The immediate lowering of blood pressure is necessary to prevent further damage to the vascular and organ system.

Treatment should be started outside the clinic by an emergency doctor. When they arrive at the hospital, the patients have to be looked after and monitored by intensive medical care.

In the first 4 hours after the high blood pressure event, the values should be decreased by 20-25%, but not below a level of 180/100 mmHg. If the blood pressure is lowered too quickly, it can lead to reduced blood flow to brain, Kidneys and heart come. In the further course of therapy, blood pressure values should be brought to a level of approx. 160/100 mmHg, provided the patient is doing well. This level will then be maintained for the next 12 to 24 hours. In addition to drugs that directly lower blood pressure, the patients also receive drugs to promote water excretion.

Prognosis of a sudden high blood pressure event

Immediate therapy for derailed blood pressure is necessary, as untreated patients with permanently high blood pressure have a very high risk of cardiovascular diseases such as strokes (apoplexy) and heart attacks and a high risk of dying from these complicating diseases.