Synonyms in a broader sense
Hypertensive crisis, Hypertensive emergency, Hypertensive emergency
Definition
The acute increase in blood pressure to values of over 230/130 mmHg is a sign of the hypertensive crisis / hypertension crisis. If symptoms affecting the heart or nervous system occur in the course of the increase in blood pressure, this is referred to as 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, becomes an absolute emergency that must be treated in a hospital. Any form of hypertension can lead to a derailment, but this acute event most frequently occurs in patients with advanced kidney dysfunction and in patients with pheochromocytoma, a hormone-forming tumor.
Symptoms of acute blood pressure rise
Patients with acute hypertension often complain of chest pain (angina pectoris), heart stumbling (cardiac arrhythmia) and shortness of breath (dyspnoea). They are not able to cope with stress and feel acutely ill. The massive increase in blood pressure can lead to headaches, vomiting, visual disturbances, confusion, neurological disorders and nosebleeds (especially nosebleeds with headaches).
Cause of the rise in blood pressure
The most common complication of acute blood pressure derailment is severe renal hypertension, i.e. an increase in blood pressure due to kidney disease, or endocrine hypertension, i.e. high blood pressure due to hormonal changes. The acute increase in blood pressure can also occur at the base of primary hypertension, e.g. when the hypertensive patient is under great tension and stress.
Primary hypertension is a form of blood pressure where there is no organic cause for the elevated blood pressure, rather the high blood pressure is the result of various trigger factors. Thus, no organ disease can be found as the cause of high blood pressure. Likewise, derailments of the values are possible if a drug therapy to lower blood pressure is abruptly terminated or interrupted.
Pregnancy can also lead to a blood pressure crisis, this is known as eclampsia. The brain and kidneys can be damaged in a hypertension crisis. The vessels of the brain dilate when blood pressure rises acutely, which means that fluid from the vessels can leak into the surrounding tissue and cause brain swelling (brain edema).
Brain haemorrhages can also occur. In the kidney, the massively high blood pressure leads to tissue loss and the formation of blood clots in the renal vessels. The organ is massively damaged, resulting in an acute restriction of the filtering function of the kidneys, which is known as acute renal failure.
The acute organ failure must be repaired as quickly as possible to prevent further and lasting damage. The heart can also be damaged by a hypertension crisis: This results in an acute strain on the left heart, as it has to pump against a greatly increased blood pressure. If the heart is unable to pump a sufficient amount of blood into the vascular system against this pressure, this is known as left heart failure.
It can also lead to chest pain and a threatening heart attack. A careful and rapid medical procedure with the aim of keeping organ damage as low as possible is necessary to treat a patient with acute blood pressure increase. The choice of medication depends 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 is different, therefore the respective procedure is described one after the other. 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 over the following 24 hours. If the blood pressure is lowered too quickly, this could lead to a reflex blood pressure increase; to avoid this, the medication is given orally, i.e. the patient receives medication to swallow.
As a rule, a hospital stay is not necessary for the treatment of the hypertensive crisis. The hypertensive emergency is a life-threatening emergency situation in which quick action must be taken. The main focus of therapy is a rapid but controlled reduction in blood pressure by means of drugs that are administered directly into the bloodstream via a venous access, which in this way has the fastest effect.
The immediate lowering of blood pressure is necessary to prevent further damage to the vascular and organ system. The treatment should already be started outside the clinic by an emergency doctor. Once in hospital, patients must be given intensive medical care and monitored.
In the first 4 hours after the hypertension event, the values should be reduced by 20-25%, but not below a level of 180/100 mmHg. If the blood pressure is lowered too quickly, blood flow to the brain, kidneys and heart may be reduced. In the further course of therapy, blood pressure values should be brought to a level of approx.
160/100 mmHg, provided the patient is well. This level is then maintained for the next 12 to 24 hours. In addition to direct blood pressure-lowering medication, the patients also receive medication to promote water excretion. – Therapy of the hypertensive crisis
- Therapy of the hypertensive emergency
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