Hypertensive crisis: symptoms and first aid
The hypertensive crisis is a sudden emergence of a persistent increase in blood pressure with symptomatic and complications typical of this condition, primarily from the target organs.The latter include the brain, the heart, the aorta - those organs, serious damage which inevitably leads to the death of a person.Table of contents: Causes and mechanism of development of hypertensive crisis Symptoms of hypertensive crisis Diagnosis of hypertensive crisis Complications of hypertensive crisis Treatment of hypertensive crisis Emergency care for hypertensive crisis
Causes and mechanism of development of hypertensive crisis
One of the most frequent questions that hypertensive patient asksDoctor, is the question of the causes of the crisis.The patient is perplexed, as he carefully observes the regimen of taking and dosage of prescribed medicines. And to your surprise finds out that the crisis can arise:
- due to severe psycho-emotional stress;
- alcohol abuse;
- sudden changes in weather, especially in meteosensitive people.
However, the most frequent cause of hypertensive crisis can be considered a sudden withdrawal of antihypertensive medication, non-compliance with medical prescriptions and inadequately selected dosages of drugs.The latter usually occurs at the very beginning of treatment( this will be discussed below).
The hypertensive crisis develops as a result of disturbed regulation of vascular tone due to a malfunction in the autonomic nervous system and excessive activation of hormonal mechanisms to maintain blood pressure.Because of this in the blood, the concentration of catecholamines and vasopressin increases - the hormones that promote pressure increase, as well as angiotensin II, aldosterone, which keep the fluid in the bloodstream, increasing the volume of circulating blood.
Because of the need to pump increasing volumes of fluid, the heart begins to experience inadequate loads for it, its need for oxygen increases.If the patient has hypertension at the same time, there are disturbances in myocardial nutrition, then at the peak of the crisis, development of left ventricular failure, infarction, arrhythmias is possible.
Excessive endothelin production leads to disruption of the integrity of the vascular wall.Under the condition of high blood pressure, any of the blood vessels can burst and if this happens in the brain, then a hemorrhagic stroke develops.Perhaps the development of ischemic form due to prolonged narrowing of the vessels in any area of the brain.This form is more favorable, but it is also extremely dangerous for the life and health of the patient.Finally, according to a hemorrhagic stroke type similar to that, a dissecting aortic aneurysm develops - the most formidable of the complications of the crisis with a lethality close to 100%.
Symptoms of hypertensive crisis
Doctors divide any crisis into two categories - complicated and uncomplicated.In the first case, against the background of increased blood pressure, there are signs of damage to target organs - the heart, brain, and aorta.In the second case, these symptoms are not present.Regardless of the category, all patients note the appearance of a number of signs of pressure increase:
- weakness( "do not hold a leg" - so patients describe this condition);
- headache in the occiput;
- visual artifacts( flashing "flies" before the eyes);
- nausea, sometimes with vomiting;
- feels the heat all over the body;
- tachycardia or heart failure.
Not all cases necessarily show all these symptoms, but complaints even on a part of them, especially if they arise not for the first time, make you suspect a hypertensive crisis.
Diagnosis of the hypertensive crisis
The diagnosis in the case of an uncomplicated crisis usually does not cause difficulties.It is enough only to measure blood pressure and compare it with the figures of the patient's "working" pressure. It is sufficient to identify both the crisis itself and the cause that caused it, allows the study of an anamnesis:
- duration of hypertension;
- treatment taken;
- possible withdrawal of the drug( most often unauthorized);
- transferred stress;
- lack of sleep.
It is much more difficult, especially at the prehospital stage, to determine the symptoms of target organ damage.Emergency physicians have only an electrocardiograph for this, which can reveal signs of myocardial ischemia.
Nevertheless, careful examination and questioning of the patient helps in determining the signs of encephalopathy( nausea, vomiting, headache, confusion, visual impairment), myocardial infarction( chest pain, arrhythmias), acute left ventricular failure( dyspnea, pale skin, Wheezing in the lungs), etc.
In a hospital environment, the following can be performed:
- chest X-ray;
- heart ultrasound;
- laboratory tests.
research data will not only establish the fact of damage to the target organ, but also determine how much it has suffered.
Complications of the hypertensive crisis
The most dangerous complications of hypertensive crisis are acute coronary syndrome, exfoliating aortic aneurysm, stroke.
Mechanisms of their development are described above, the prognosis for these pathologies is very, very serious.That is why the "ambulance" leaves for any challenge associated with hypertension and does everything possible to stop the rise in blood pressure.
Treatment of hypertensive crisis
In uncomplicated crisis, treatment does not present any special difficulties.Often, patients, independently identifying the rise in blood pressure, take an additional dose of the drug prescribed to them and do not even consult a doctor.However, sometimes the effect is incomplete and then you have to call an ambulance or visit a local therapist.
The goal of treatment of a crisis is to bring the systolic pressure to a figure of 139 and below, and the diastolic pressure is 99 or lower.Usually, oral intake of one of the hypotensive drugs - captopril, nifedipine, clonidine, metoprolol - along with taking a diuretic preparation( most often furosemide) is usually enough for this.This usually proves sufficient to stop the crisis.Hospitalization in such cases is not required.
Drugs used to treat uncomplicated hypertensive crisis
|Preparations||Dosage and route of administration||Side effects||Effects|
|Clonidine||0.075-0.15 mg oral or 0.01% p-p 0.5-2 ml IM or IVD||Dry mouth, drowsy.Contraindicated in patients with AB blockade, bradycardia.||After 10-60 minutes.|
|Captopril||12.5-25 mg orally or sublingually||Orthostatic hypotension.||After 30 minutes.|
|Dibazole||1% - 4-5 ml IV 0.5% - 8-10 ml IV||More effective in combination with other antihypertensive drugs.||After 10-30 minutes.|
|Propranolol||20 - 80 mg inside||Bradycardia, bronchoconstriction.||After 30-60 minutes.|
|Dripidol||0.25% rp 1 mL IM or IV||Extrapyramidal disorders.||After 10-20 minutes.|
|Nifedipine||5-10 mg inside or sublingually||Headache, tachycardia, redness, angina may develop.||After 10-30 minutes.|
Important: only your doctor can choose the exact dosage.
Much more difficult to treat a crisis, complicated by the defeat of target organs.If, in uncomplicated form, blood pressure should decrease gradually( up to 6 hours), then, if complicated, it should be quenched as soon as possible.The reason is that the development of complications seriously worsens the prognosis of the disease and in dozens of times increases the risk of death.
In case of a complicated crisis, injectable forms of medications are used:
- enalaprilat( with left ventricular failure);
- nitroglycerin( with acute coronary syndrome and left ventricular failure);
- sodium nitroprusside( with hypertensive encephalopathy);
- β-blockers( with ACS and exfoliating aortic aneurysm);
- Fentolamine( a drug that suppresses adrenaline activity in pheochromocytoma).
- Diuretics( especially with left ventricular lack of senility);
- Neuroleptics( droperidol).
Doses of drugs are selected by doctors in such a way as quickly as possible to lower blood pressure.
Please note: is the most popular magnesia( magnesium sulfate), which is able to have a very fast effect, is being used less and less now.The reason is the available scientific data on the decrease in life expectancy in people who have had hypertensive crisis with this drug.In addition, there are cases of a sharp jump in blood pressure after the end of the effect of magnesia and the development of severe complications.
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It should be remembered that arterial hypertension is by no means an unpretentious disease with which one can live with the clover.The high risk of developing fatal complications with increasing figures of pressure coupled with the widespread prevalence of this pathology makes it perhaps the most deadly among all cardiovascular diseases.
Gennady Bozbey, medical reviewer, ambulance doctor