Brief overview
- Symptoms: red head, severe headache, pressure in the head, nosebleeds, nausea, vomiting, tremors; in hypertensive emergency: chest tightness, shortness of breath, numbness and visual disturbances
- Causes: Worsening of existing high blood pressure (possibly due to discontinuation of medication), more rarely other diseases such as kidney dysfunction or disease of hormone-producing organs, drug abuse, alcohol withdrawal
- Treatment: Monitoring of blood pressure with prompt but gradual blood pressure reduction using medication (outpatient or inpatient); in an emergency, immediate blood pressure reduction with close blood pressure monitoring in the intensive care unit
- Examinations and diagnosis: Physical examination, blood pressure measurement, blood and urine tests if necessary
- Course and prognosis: With immediate treatment, the prognosis is usually good and blood pressure returns to normal within 24 hours; in an emergency, depending on the extent of organ damage
- Prevention: Regular blood pressure checks and careful intake of medication
What is a hypertensive crisis or hypertensive emergency?
In a hypertensive crisis, blood pressure rises very quickly to critical levels. These exceed 230 mmHg (i.e. millimeters Hg) for systolic pressure and 130 mmHg for diastolic blood pressure. Normally, a healthy blood pressure is around 120 to 80 mmHg.
In contrast, in a hypertensive emergency, there is a danger to life as organ damage has already occurred. However, there is a possibility that a hypertensive crisis – especially if it is not treated in time – can quickly turn into a hypertensive emergency.
What are the signs of a hypertensive crisis?
A hypertensive crisis does not always cause clear symptoms. Particularly in people who have already had high blood pressure for some time, the symptoms are often uncharacteristic. The following symptoms may indicate a hypertensive derailment:
- Red head
- Headache or extreme pressure in the head
- Nausea and vomiting
- Nosebleeds
- Severe trembling
In a hypertensive emergency, the symptoms are more obvious. For example, the following occur
- Sudden tightness in the chest (angina pectoris)
- Difficulty breathing with rales (due to water accumulation in the lungs), shortness of breath (apnea)
- Visual disturbances
- Numbness
What causes a hypertensive crisis?
A hypertensive crisis has many possible causes. It usually occurs in connection with existing high blood pressure (primary or secondary arterial hypertension), sometimes associated with the sudden discontinuation of antihypertensive medication.
Similarly, certain diseases of hormone-producing organs can lead to the sudden release of a large amount of blood pressure-inducing messenger substances, which cause blood pressure to rise to dangerous levels within minutes. This can happen, for example, in pheochromocytoma (a tumor of the adrenal medulla).
More rarely, alcohol withdrawal or drug abuse (cocaine, amphetamines) leads to a blood pressure crisis.
See a doctor immediately in the event of a hypertensive crisis
If a hypertensive crisis is suspected, it is important to act immediately! This is the only way to prevent possible organ damage. As a rule, doctors initially monitor the patient with a hypertensive derailment in hospital (as an inpatient).
Antihypertensive drugs are used for treatment, which slowly lower the blood pressure. At the same time, the doctor closely monitors whether the blood pressure is falling. The aim of the treatment is to effectively lower the blood pressure to a non-critical level within 24 hours. It is possible for the medication to be administered at home, i.e. on an outpatient basis by the family doctor, for example.
In the event of a hypertensive emergency, call the emergency doctor immediately (emergency number 112)!
How to recognize a hypertensive crisis?
The emergency doctor or family doctor are usually the people to contact in the event of a hypertensive crisis. They will first examine the patient physically and check their blood pressure. In most cases, this allows them to determine and confirm that the blood pressure is high.
Depending on the patient’s physical condition and existing symptoms, further examinations may be necessary, especially if pre-existing conditions are present. For example, doctors usually take a blood and urine sample.
Read more about the tests in the article Hypertension.
How long does a hypertensive crisis last?
The prognosis for a hypertensive crisis is significantly better than for a hypertensive emergency. It is usually possible to successfully lower the blood pressure with medication within the required time (around 24 hours) without damaging any organs.
In a hypertensive emergency, it is important to lower the blood pressure immediately and in a very controlled manner. The prognosis depends on whether the functioning of the organs has been restored or secondary damage (e.g. due to a stroke, kidney or eye damage) has been avoided.
A hypertensive crisis can be avoided
A hypertensive crisis usually occurs when an existing high blood pressure worsens. This can be prevented by those affected either checking their blood pressure regularly themselves or having it checked by a doctor. It is also important to take the prescribed medication carefully.
