Hypertensive crisis or hypertensive emergency is a sudden increase in blood pressure to levels greater than 200/130 mmHg. The condition must be treated immediately or it may progress to life-threatening hypertensive emergency.
What is a hypertensive crisis?
Hypertensive crisis refers to a sudden high rise in blood pressure. A distinction is made between hypertensive crisis and hypertensive emergency. In both, blood pressure values higher than 200 mmHg systolic and/or 130 mmHg diastolic are present. While a hypertensive crisis is not life-threatening because no organ damage is caused, the hypertensive emergency is a complication. In this case, the high blood pressure can cause damage to organs, and cerebral hemorrhage, stroke, or myocardial infarction can occur. The hypertensive crisis always carries the risk of turning into a hypertensive emergency. Sudden elevation of blood pressure is one of the most common internal medicine emergencies; approximately one-quarter of these patients suffer a hypertensive crisis or emergency. Women are much less likely to be affected than men.
Causes
Various circumstances can be considered as causes of hypertensive crisis. Often, high blood pressure (primary hypertension) already exists but is not treated as directed by the physician. Patients do not carry out therapy consistently, medications are not taken regularly, alcohol is consumed in excess despite the high blood pressure, drugs, especially stimulant amphetamines, are used, or the diet remains too fatty and rich. Stress in pre-existing hypertension can also trigger a hypertensive crisis. Another cause can be hypertension during pregnancy in women, the hypertensive crisis here is called eclampsia. Kidney disease and hormonal disorders also lead to elevated blood pressure, which can derail into a hypertensive crisis.
Symptoms, complaints, and signs
Hypertensive crisis can cause a whole range of symptoms and complaints, which can vary in type and severity. Headache, shortness of breath, and chest pain are typical of the condition. Accompanying symptoms usually include nausea and vomiting, nosebleeds or dizziness. The elevated blood pressure can also cause neurological disorders such as perceptual disturbances or paralysis. If the hypertensive crisis is not treated promptly, the high blood pressure sometimes causes irreversible damage to the organs. Externally, the disease is manifested by a severely reddened head, sweating, and bulging veins in the neck and arms. Many sufferers also tremble or suffer from convulsions that increase in intensity as the disease progresses and are occasionally associated with pain. A hypertensive crisis can cause a heart attack or circulatory collapse. A heart attack is initially manifested by a rapid increase in chest pain accompanied by numbness in the right arm and difficulty swallowing. Circulatory collapse can occur rapidly in hypertensive crisis – there are initially mild disturbances of consciousness that rapidly develop into dizziness and brief moments of unconsciousness. If immediate treatment is not given, the patient becomes unconscious and there is acute danger to life.
Diagnosis and course
Symptoms of hypertensive crisis can vary in severity. Older people who have had hypertension for a long time can often tolerate the sudden rise in blood pressure better than young people who normally have low blood pressure. They usually experience the more severe symptoms. Typical symptoms include headache, shortness of breath, chest pain, nausea, nosebleeds, vomiting or visual disturbances. Some sufferers experience neurological disorders such as numbness or perceptual disturbances. Confused states also occur. For the emergency physician, it is initially not important whether a hypertensive crisis or already a hypertensive emergency is present. If an extremely elevated blood pressure is measured, it must be lowered slowly and immediately in both cases. In the further course, he then obtains additional information by asking about the symptoms and the medical history.Other tests, such as blood and urine tests, ECG (measurement of heart currents), X-ray of the lungs, computed tomography (CT) of the head, neurologic examinations, and funduscopy of the eyes, are among the usual methods used when a hypertensive crisis is suspected.
Complications
This crisis can result in a life-threatening condition for the patient, so immediate treatment is necessary. In the worst case, the affected person may die from the symptoms of this crisis. The sharp rise in blood pressure usually results in headaches and a severely reddened head. The affected person continues to suffer from vomiting and severe nausea. The patient’s ability to cope with stress also decreases enormously and ordinary activities can no longer be carried out easily. Sufferers suffer from paralysis and numbness that can spread over the entire body and may continue to lose consciousness. It is not uncommon for chest pains to occur, and a heart attack may result. It is not uncommon for patients to suffer from nosebleeds and visual disturbances as well. A general unsteadiness of the patient occurs, which decreases the quality of life. The treatment is carried out with the help of medications and aims at lowering the blood pressure. Complications and irreversible damage can then occur if the lowering of blood pressure occurs too quickly. Furthermore, treatment of the underlying disease is also necessary to prevent this crisis in the future. In some circumstances, this may also reduce life expectancy.
When should you go to the doctor?
In the event of sudden high blood pressure, immediate action is necessary. If there is severe internal heat, rapid heartbeat, sweating, restlessness and redness of the skin, an emergency physician should be called or a hospital visited immediately. If the symptoms are not due to immense physical or athletic exertion, the affected person needs help. Since hypertensive crisis can lead to loss of life without immediate medical care, an ambulance should be alerted. A feeling of pressure inside the body, tightness of muscles and tendons, and nervousness are warning signs of the organism. If treatment is not initiated as quickly as possible, there may be lifelong consequential damage in addition to death. Paralysis or failure of individual functions are possible. In most cases, a survivor of a hypertensive crisis requires daily care and support in coping with everyday life. If a headache, shortness of breath, or difficulty breathing occurs, call a physician. Nausea and sudden vomiting are other signs, of discord. The affected person must be examined as soon as possible in case of sensory disturbances, tingling in the limbs or numbness. Persistent stress or phases of emotional challenge can be the cause of the existing physical problems. A visit to the doctor is therefore already recommended as soon as the affected person has blood pressure problems over a longer period of time.
Treatment and therapy
A hypertensive crisis absolutely requires medical treatment so that it does not derail into a hypertensive emergency. This represents an acute life-threatening emergency that must be treated immediately by an emergency physician. Therapy for an emergency begins on the scene and continues during transport to the hospital. Blood pressure must be lowered immediately, but only slowly. The lowering of the pressure in a hypertensive emergency must be monitored intensively so that it does not proceed too quickly. If the blood pressure dropped too quickly, the organs and especially the brain would not be able to process it, and bleeding and irreversible damage would result. In hypertensive crisis, it is also necessary to lower the blood pressure slowly. However, this treatment can also take place at home with medication in tablet form, whereas in the hypertensive emergency the blood pressure-lowering substances must be administered by infusion. In addition, patients are given drugs that promote water excretion (diuretics). Finally, after normalization of blood pressure, any underlying disease must be treated to prevent recurrence of hypertensive crisis.
Outlook and prognosis
The prognosis of a hypertensive crisis or emergency depends on the promptness of adequate medical care for the patient.The sooner intensive medical care is possible, the better the chances of a good prognosis. A complete recovery is possible under optimal conditions. In many cases, a few minutes decide the further development of the patient’s health. If medical care is provided too late or not at all, the risk of premature death of the patient increases significantly. Alternatively, permanent dysfunction of various systems in the organism is to be expected, leading to a severe impairment of the general quality of life. Only rarely can a subsequent alleviation of the existing complaints be documented without medical assistance in the emergency situation. The reason for this is that the administration of medication leads to a reduction in blood pressure within a short period of time. If it fails to do so, the blood pressure continues to rise, causing the blood vessels to burst. Medication is necessary to stabilize the patient. In addition, controlled lowering of blood pressure is needed to prevent further complications. If this is successful, a further treatment and therapy plan can be drawn up. This usually involves remedying the trigger of the hypertensive crisis or making the necessary changes in current living conditions.
Prevention
Since a hypertensive crisis usually occurs when hypertension is already present, it is certainly possible to prevent it by consistently treating hypertension, paying attention to a healthy diet, avoiding stress, and getting enough exercise. Regular control of blood pressure is also helpful, especially in the case of existing underlying diseases that bring the symptom of hypertension.
Follow-up care
After a hypertensive crisis, it is important to monitor blood pressure levels regularly. In the case of hypertensive emergency, close monitoring (at least 1x/30min) must be performed during follow-up. To prevent a further derailment of blood pressure and the associated stress on the cardiovascular system, underlying hypertension should be treated permanently with the help of drug therapy. The choice of medication and the target values depend on the age and concomitant diseases of the patient. The aim of the therapy is a continuous reduction in blood pressure. Existing risk factors should also be assessed in order to minimize the risk of a renewed drop in blood pressure. Non-pharmacological measures include adherence to a special diet plan. A healthy, low-salt diet (maximum six grams of table salt per day) is desirable. There should be plenty of fruit and vegetables and a simultaneous reduction in certain foods (for example, saturated fatty acids, which are increasingly found in foods of animal origin). Likewise, substances that have a negative effect on the cardiovascular system should be avoided. It is advisable to avoid alcohol, coffee and nicotine in general. In obese patients, efforts must be made to normalize body weight. Likewise, the regular practice of an endurance sport is recommended.
What you can do yourself
Hypertensive emergency but also hypertensive crisis is a potentially life-threatening emergency. This must be treated by a specialist in any case. In the acute situation, the affected person can first and foremost make sure to remain calm. For example, relaxation exercises can be used to try to have a positive influence on high blood pressure. After the acute phase, the main focus is on prophylactic measures that can minimize the risk of a renewed crisis. It is particularly important to take the prescribed antihypertensive medication regularly and correctly. Only reliable intake enables a lasting reduction in blood pressure. In the long term, those affected should strive to change their lifestyle. This includes weight reduction, preferably through a Mediterranean diet with plenty of light fish, vegetables and olive oil. In addition, it is advisable to keep the salt content in the diet low. Smoking, alcohol and excessive caffeine consumption should be avoided completely. Regular exercise and light endurance sports for at least 30 minutes, three to five days a week, can also reduce hypertension and thus the risk of a hypertensive crisis. Excessive stress is a possible trigger for a hypertensive crisis, so it is important to avoid stress in everyday life and at work if possible.
