Last updated date: 04-Apr-2023
Originally Written in English
Management of hypertensive crisis
A hypertensive crisis is a medical emergency characterized by a sudden, severe increase in blood pressure that can lead to life-threatening complications if left untreated. The condition is generally classified into two types: hypertensive urgency and hypertensive emergency, depending on the presence of acute target organ damage. Regular blood pressure monitoring, taking medications as prescribed, maintaining a healthy lifestyle, managing underlying medical conditions, and seeking prompt medical attention are important steps to help prevent a hypertensive crisis.
What is a Hypertensive crisis?
A hypertensive crisis is a severe and sudden increase in blood pressure that can lead to serious complications such as stroke, heart attack, or organ damage. This condition is typically defined as a systolic blood pressure reading (the top number) of 180 mm Hg or higher, or a diastolic blood pressure reading (the bottom number) of 120 mm Hg or higher.
There are two types of hypertensive crises:
- Hypertensive Urgency: This is a situation where blood pressure rises severely, but there is no evidence of immediate organ damage. Symptoms may include severe headache, shortness of breath, and nosebleeds.
- Hypertensive Emergency: This is a more severe form of a hypertensive crisis where blood pressure rises rapidly and leads to immediate organ damage. Symptoms may include severe chest pain, severe headache, confusion, vision changes, seizures, and loss of consciousness.
Hypertensive crises are medical emergencies that require prompt treatment. Treatment may involve medications to lower blood pressure gradually and control symptoms, as well as monitoring for complications such as kidney damage, heart failure, or stroke.
What causes Hypertension crisis?
There are several possible causes of a hypertensive crisis, including:
- Failure to manage high blood pressure: If an individual with high blood pressure (hypertension) fails to manage their condition through lifestyle changes and/or medication, it can lead to a hypertensive crisis.
- Certain medications or substances: Some medications, such as stimulants, decongestants, and illegal drugs like cocaine and amphetamines, can cause a sudden increase in blood pressure.
- Kidney disease: Chronic kidney disease can cause an accumulation of fluids and waste products in the body, which can lead to a hypertensive crisis.
- Hormonal disorders: Disorders such as pheochromocytoma (a rare adrenal gland tumor) and hyperthyroidism (overactive thyroid gland) can cause a sudden increase in blood pressure.
- Pregnancy-related conditions: Conditions such as preeclampsia and eclampsia can cause a sudden increase in blood pressure in pregnant women, which can be life-threatening for both the mother and the fetus.
- Certain medical conditions: Conditions such as stroke, heart attack, and aortic dissection can cause a sudden increase in blood pressure.
What drugs cause Hypertensive crisis?
Certain medications and substances can cause a sudden increase in blood pressure, which may lead to a hypertensive crisis. Some examples of drugs that can cause hypertensive crisis include:
- Stimulants: Drugs such as cocaine, amphetamines, and methamphetamines can cause a sudden increase in blood pressure.
- Decongestants: Some over-the-counter cold and allergy medications, such as pseudoephedrine, can raise blood pressure and cause a hypertensive crisis.
- Monoamine oxidase inhibitors (MAOIs): These are a type of antidepressant medication that can interact with certain foods and other medications to cause a sudden increase in blood pressure.
- Immunosuppressive drugs: Medications used to suppress the immune system, such as cyclosporine, can cause a hypertensive crisis.
- Oral contraceptives: Certain types of birth control pills can increase blood pressure in some women, which may lead to a hypertensive crisis.
- Certain herbal supplements: Some herbal supplements, such as ephedra and yohimbine, can increase blood pressure and cause a hypertensive crisis.
What are the symptoms of Hypertensive crisis?
The symptoms of hypertensive crisis may vary depending on the severity of the condition.
In hypertensive urgency, symptoms may include:
- Severe headache
- Shortness of breath
- Anxiety or nervousness
- Chest pain
In hypertensive emergency, symptoms may include:
- Severe headache
- Chest pain
- Shortness of breath
- Confusion or changes in mental status
- Vision changes or blurry vision
- Nausea or vomiting
- Weakness or numbness in the arms, legs, or face
- Loss of consciousness
It's important to note that hypertensive crises may not always cause symptoms. In some cases, individuals may not even be aware that their blood pressure has risen to dangerous levels. That's why it's important to regularly monitor blood pressure and seek medical attention if there are any concerns.
How is a Hypertensive crisis diagnosed?
A hypertensive crisis is typically diagnosed based on a combination of medical history, physical examination, and laboratory tests. During a medical evaluation for a hypertensive crisis, a healthcare provider will typically:
- Take a medical history: The healthcare provider will ask about symptoms, medical history, and any medications or supplements the individual is taking.
- Perform a physical examination: The healthcare provider will perform a physical examination to check for any signs of organ damage, such as heart or kidney damage.
- Measure blood pressure: The healthcare provider will measure blood pressure using a sphygmomanometer to determine whether it is at a dangerous level.
- Order laboratory tests: Blood and urine tests may be ordered to check for signs of organ damage and to evaluate electrolyte levels.
- Conduct imaging tests: Imaging tests, such as a chest X-ray or a CT scan, may be ordered to check for any signs of organ damage.
In some cases, a healthcare provider may order additional tests to determine the underlying cause of the hypertensive crisis, such as an electrocardiogram (ECG) to check for heart damage or a urinalysis to check for kidney damage.
Prompt medical attention is important if experiencing symptoms of a hypertensive crisis, as early detection and treatment can help prevent complications.
How is a Hypertensive crisis treated?
The treatment of a hypertensive crisis will depend on the severity of the condition and the presence of any underlying medical conditions. In general, the goal of treatment is to lower blood pressure quickly and safely to prevent complications. Treatment may include:
- Hospitalization: People with a hypertensive crisis may need to be hospitalized, particularly if their blood pressure is very high or they are experiencing symptoms of organ damage.
- Medications: Medications to lower blood pressure quickly may be given through an IV, such as nitroglycerin, nitroprusside, or labetalol.
- Monitoring: Blood pressure and other vital signs will be closely monitored, and blood tests may be ordered to check for signs of organ damage.
- Addressing underlying causes: If an underlying medical condition, such as kidney disease or a hormonal disorder, is causing the hypertensive crisis, it will need to be treated.
- Lifestyle changes: Once the hypertensive crisis is under control, healthcare providers may recommend lifestyle changes, such as a healthy diet, regular exercise, and stress management, to help manage blood pressure in the long term.
It's essential to seek prompt medical attention if experiencing symptoms of a hypertensive crisis, as early treatment can help prevent complications. Regular blood pressure monitoring and management of hypertension can also help prevent a hypertensive crisis from occurring.
What are the complications of a Hypertension crisis?
A hypertensive crisis can lead to serious complications, some of which may be life-threatening. The complications may depend on the severity and duration of the crisis and may include:
- Stroke: A hypertensive crisis can increase the risk of a stroke, which occurs when blood flow to the brain is interrupted or reduced.
- Heart attack: A hypertensive crisis can also increase the risk of a heart attack, which occurs when blood flow to the heart is blocked.
- Aortic dissection: A hypertensive crisis can cause the walls of the aorta (the main artery that carries blood from the heart) to tear, leading to severe chest pain and potentially life-threatening complications.
- Kidney damage: High blood pressure can damage the blood vessels in the kidneys, leading to reduced kidney function or even kidney failure.
- Vision loss: A hypertensive crisis can damage the blood vessels in the eyes, leading to vision problems or even permanent vision loss.
- Pulmonary edema: This is a condition where fluid accumulates in the lungs, making it difficult to breathe. A hypertensive crisis can increase the risk of pulmonary edema.
- Cognitive impairment: A hypertensive crisis can cause changes in mental status, confusion, or cognitive impairment.
How can I prevent a Hypertensive crisis?
There are several steps you can take to help prevent a hypertensive crisis:
- Monitor blood pressure regularly: Regular blood pressure monitoring is important to detect any changes in blood pressure levels. Work with your healthcare provider to determine how often you should check your blood pressure and what your target blood pressure range should be.
- Take medications as prescribed: If you have been prescribed medications to manage hypertension, be sure to take them as directed by your healthcare provider. Do not stop taking medications without first consulting with your healthcare provider.
- Maintain a healthy lifestyle: A healthy diet that is low in sodium and rich in fruits, vegetables, and whole grains can help lower blood pressure. Regular exercise, maintaining a healthy weight, and managing stress can also help prevent hypertension.
- Avoid smoking and excessive alcohol consumption: Smoking and excessive alcohol consumption can contribute to hypertension and increase the risk of a hypertensive crisis.
- Manage underlying medical conditions: If you have underlying medical conditions such as diabetes or kidney disease, it's essential to manage them properly to help prevent hypertension and its complications.
- Seek prompt medical attention: If experiencing symptoms of hypertension, such as headaches or blurred vision, seek prompt medical attention. Early detection and treatment can help prevent a hypertensive crisis from occurring.
By following these steps and working closely with your healthcare provider, you can help prevent hypertension and its associated complications, including a hypertensive crisis.
What is the difference between Hypertension crisis and Hypertension emergency?
Hypertension crisis and hypertension emergency are two different levels of severity of high blood pressure.
Hypertension crisis is a severe increase in blood pressure, but without evidence of target organ damage. In this case, the blood pressure is usually greater than 180/120 mm Hg. However, individuals experiencing a hypertensive crisis may not necessarily have symptoms. Common symptoms include severe headaches, shortness of breath, nosebleeds, chest pain, and anxiety.
On the other hand, hypertension emergency is a severe increase in blood pressure that is accompanied by evidence of acute organ damage. This may include symptoms such as severe headache, shortness of breath, chest pain, blurry vision, confusion, seizures, or loss of consciousness. Hypertension emergency is a medical emergency and requires immediate medical attention to prevent potentially life-threatening complications such as heart attack, stroke, or kidney failure.
In summary, the key difference between hypertension crisis and hypertension emergency is the presence or absence of evidence of acute organ damage. Hypertension emergency requires urgent medical attention, while hypertension crisis can often be managed in an outpatient setting with close monitoring and medication management.
In conclusion, a hypertensive crisis is a severe increase in blood pressure that can lead to life-threatening complications if left untreated. It is important to seek prompt medical attention if experiencing symptoms of a hypertensive crisis, such as severe headaches, shortness of breath, chest pain, or blurred vision. Treatment may include hospitalization, medications to lower blood pressure quickly, monitoring, addressing underlying causes, and lifestyle changes. Regular blood pressure monitoring, taking medications as prescribed, maintaining a healthy lifestyle, managing underlying medical conditions, and seeking prompt medical attention are important steps to help prevent a hypertensive crisis.