Hypertensive crisis

The hypertensive crisis is an emergency that is caused by excessive high blood pressure and which is manifested by a picture with the clinic of the lesion of a particular target organ. When it is necessary to urgently reduce blood pressure to prevent damage to third-party organs. This pathological condition is one of the most frequent causes of medical ambulances common for calling a car. In Western Europe in the past twenty years there has been a decrease in the incidence of hypertensive crisis in patients with hypertension. This is due to the improvement of the treatment of arterial hypertension and the growth of timely diagnosis of this disease.

Hypertensive cause crisis

The cause of crises in hypertensive disease is different. Hypertensive crises occur in the presence of arterial hypertension of any origin( hypertonic and symptomatic hypertension in various forms), also with the rapid discontinuation of drugs that lower blood pressure( antihypertensive drugs).This condition is also called "withdrawal syndrome".

Causes that contribute to the emergence of hypertensive crises:

Hypertensive crisis with pheochromocytoma is a consequence of increased catecholamines in the blood. It also occurs with acute glomerulonephritis.

With the syndrome, aldosterone hypersecretion occurs, which leads to increased excretion of potassium and promotes redistribution of electrolytes in the body, thereby leading to the accumulation of sodium and to an increase in peripheral vascular resistance in the long run.

Occasionally hypertensive crisis develops due to the mechanism of the reflex response in response to a lack of oxygen( hypoxia) or brain ischemia( ganglion blockers use, the use of sympathomimetics, and the abolition of antihypertensive drugs).

The risk of hypertensive crises is present in acute damage to certain target organs. Disorders of regional blood circulation are revealed in the form of acute encephalopathy of hypertensive, acute coronary insufficiency, stroke and acute cardiac insufficiency. Damage to target organs occurs both at the peak of the crisis, and because of a sharp decrease in arterial pressure, especially in elderly people.

Identify 3 mechanisms of hypertensive crisis development:
- increase of arterial pressure with excessive reaction of vasoconstrictive cerebral vessels;
- a violation of the local circulation of the brain;
- hypotonic crises.

hypertensive crisis symptoms

main symptom of crisis hypertensive is a sharp increase in blood pressure, which manifests significant increase in circulation of brain and kidney, because of which substantially increases the risk of serious complications of cardiovascular( myocardial infarction, stroke, hemorrhage, subarachnoid, aortic aneurysm dissecting, acuteRenal failure, pulmonary edema, acute coronary insufficiency, etc.).

Development of the hypertensive crisis manifests itself: nervous excitement, anxiety, anxiety, frequent palpitations, cold sweat, sensation of lack of air, tremor of hands, goosebumpiness, red face.

Due to impaired cerebral circulation, nausea, dizziness, vomiting, and visual impairment appear.
Symptoms in hypertensive crises are very diverse. But still, the most frequent sign that is observed in the early stages during the development of crises is headache, which, in addition, can be accompanied by vomiting, nausea, dizziness, tinnitus. As a rule, this headache is aggravated by sneezing, movement of the head, defecation. Moreover, it is also accompanied by pain in the eyes with eye movements and photophobia.

When a malignant rotation occurs in the development of hypertension, the headache appears due to a significant increase in arterial pressure and intracranial pressure, cerebral edema and is accompanied by nausea, impaired vision.
Another common manifestation of hypertensive crises is dizziness - while it seems that the surrounding objects, as it were, "spin".There are two types of dizziness: 1) dizziness, which arises and intensifies with changes in the position of the head, 2) dizziness, which appears independently of the position of the head and which is not accompanied by a sense of movement.

Help with hypertensive crisis

First aid for hypertensive crisis:

Depending on the complexity of the patient's condition, you need to call an ambulance.

Put the patient in a semi-sitting position( for example, in a chair), provide peace, put a small pillow under his head.

A person who suffers from arterial hypertension should talk with the doctor in advance about what medications he should take to stop the hypertensive crisis. As a rule, it can be Kapoten( ½-1 tablet under the tongue until complete resorption) or Corinfar( 1 tablet under the tongue until complete resorption).

It is not superfluous to also take a sedative( Valocordin, Corvalol).

It is necessary to record the values ​​of the arterial pressure and heart rate. You can not leave the patient unattended. The following medical advice will be provided to the patient by the physician who arrived.

If the hypertensive crisis can not be stopped or there are complications of it, or it arose for the first time, then such a patient needs urgent hospitalization in a cardiology hospital.

When hypertensive crisis is most often used:

- Clonidine ( drug for lowering blood pressure) orally 0.2 mg, then 0.1 mg every hour until pressure decreases;By intravenous drip method, 1 ml of 0.01% in 10 ml of 0.9% sodium chloride.

- Nifedipine ( calcium channels blocker, dilates coronary and peripheral vessels, and also relaxes smooth muscles) by 5, by 10 mg in Table. Form chew, and then put under the tongue or swallow;With caution in hypertensive encephalopathy, heart failure with pulmonary edema, edema of the optic nerve disk.

- Sodium nitroprusside ( vasodilator) is intravenously driped at a dosage of 0.25-10 mg / kg per minute, after the dosage is increased by 0.5 mg / kg per minute every 5 minutes. It will also be relevant for the simultaneous development of encephalopathy of hypertensive, renal insufficiency, with the dissecting aortic aneurysm. If there is no pronounced effect within 10 minutes after reaching the maximum dose, the administration is discontinued.

- Diazoxide ( direct vasodilator) 50 mg-150 mg intravenously bolus for 10-30 seconds or slow administration of 15 mg-30 mg per minute for 20-30 minutes. There may be side effects, such as: tachycardia, arterial hypertension, nausea, angina pectoris, swelling, vomiting.

- Captopril ( ACE inhibitor) 25-50 mg per lingual.

- Labetalol ( beta-adrenoblocker) 20-80 mg intravenously by bolus every 10-15 minutes or by drop method 50-300 mg at 0.5-2 mg per minute. Recommended for encephalopathy, kidney failure.

- Fentolamine ( alpha-adrenoblocker) 5-15 mg once intravenously struino with hypertensive crisis, which is associated with pheochromocytoma.

- Enalapril ( ACE inhibitor) by intravenous jet injection for 5 minutes every 6 hours at a dose of 0.625-1.25 mg, diluted in 50 ml of 5% glucose solution or in physiological solution;With hypertensive crisis in patients with exacerbation of ischemic heart disease, encephalopathy, chronic congestive heart failure.

When the hypertensive crisis is suppressed, the drugs listed above can be used both in combination with each other and in combination with other antihypertensive agents, especially with ß-adrenoblockers and diuretics.

Hypertensive crisis treatment

With a hypertensive crisis with complications, any delay in treatment can lead to irreversible consequences. The patient is hospitalized in the intensive care unit and immediately begins to administer one of the following drugs intravenously.

Drugs for intravenous administration in hypertensive complicated crises

Name	Dosage and route of administration. Starting			Notes Duration
Drugs which relax vessels
Sodium Nitroprusside	B / drip 0.25-10 ug / kg per minute( 50-100 ml in 250-500 ml 5% glucose)	Immediately	3 minutes	Immediately reduces blood pressure in hypertensive crises. Enter under the control of blood pressure. Nitroglycerine
	B / drip, 50-200 mcg	minute 5 minutes 10 minutes		Effective with myocardial infarction, congestive heart failure. Nicardipine
	B / drip, 5-15 mg per hour for 10 minutes		12 hours at	prolonged administration is contraindicated in patients with heart failure.
Verapamil	5-10 mg	5 minutes	One hour	Contraindicated with heart failure in patients with
Hydralazine	In-stream, jet, 10-20 mg per 20 ml isotonic solution	20 min	6 hours	Repeat the injectionIn 3-6 hours.
Enalaprilat	IV, 1.25-5 mg	30 min	12 hours	Effective in heart failure of the left ventricle
Nimodipine	IV, drip, 15 mg / kg per hour	20 min	4 hours	In case of hemorrhagesSubarachnoid
Fenolodopam	In / in, drip, 0.1-0.3 μg / kg per minute	5 min	30 minutes	Effective in many hypertensive crises
Adrenoceptor blocking agents
Labetalol	In-vivo, jet, 20-80 mgAt a rate of 2 mg per minute	10 min	5 hours	Contraindications: cardiacfailure. Propranolol
	BH / in infusion of 5 mg at a rate of 0.1 mg per minute for 20 minutes		3 chasa	mainly in coronary syndrome and dissecting aortic aneurysm
Esmolol	B / drip 250-500 ug / kg per minuteFor a minute	1 minute	10 minutes	Is the main drug in the postoperative hypertensive crisis and exfoliating aneurysm of the aorta
Trimetaphane Camylate	IV, dropwise, 1-4 mg / min	Instantly	3 minutes	For hypertensive crises with edema of the brain, Lung or exfoliating aorta
aneurysm clonidine( clonidine)	V / a 0.5-1.0 mL or intramuscularly 0.5 ml of 0.01% solution	5 min	5 hours	Precautions Azametony bromide stroke
	B / 0,2-0.75 ml or intramuscularly 1 ml of 5% solution of	15 min	3 hours	Causes hypotension of orthostatic.
Fentolamine	Intravenous	One minute	10 minutes	Especially with pheochromocytoma.

Hypertensive crisis

emergency care for hypertensive crisis emergency care is provided for the purpose, trying as quickly as possible to reduce the blood pressure of a person, or irreversible organ damage internal escape.

Therefore, the use of the following drugs should always be at hand if necessary to stop the hypertensive crisis in an emergency condition: either Corinfar or Kapoten, with an upper( systolic blood pressure more than 200 mmHg or Clopheline sublingually. The effect will come after half an hour. When the arterialThe pressure dropped by twenty-five percent, then it is not necessary to reduce it more rapidly. The above measures will be sufficient, but if with the use of these drugs the condition naThe patient does not improve or worsens, on the contrary, medical first aid should be called forth immediately. The early treatment to the doctor, and the call of emergency medical care in a hypertensive crisis, will allow for effective treatment and avoid irreparable consequences.

Call 03 to call an emergency medical team, It is necessary to formulate( clearly) to the dispatcher the symptoms of the patient and the indices of his arterial pressure. Basically, hospitalization can be avoided, provided that the hypertensive crisis in the patient is not complicated by internal organ injuries. But you also need to be prepared for the fact that hospitalization may be needed if the hypertensive crisis first arose.

Before arrival of ambulance it is necessary: ​​

For a patient with an attack of hypertensive crisis, several additional pillows should be placed in the bed, thus giving him a semi-sitting position of the body. This very important measure is necessary for the prevention of suffocation or labored breathing, and it can often occur during a hypertensive crisis.

In case a person is already on an outpatient treatment for hypertension, he must necessarily take a dose( extraordinary) of his hypotensive drug. The medicinal preparation will act better in the best way, if you take it sublingually, so to speak, resorption under the tongue.

It is necessary to reduce the arterial pressure by 30 mm. Mercury column for half an hour and 50 mm. The mercury column for one hour from the initial blood pressure. When it was possible to achieve a good lowering, then to take additional methods of lowering blood pressure should not be. It is also dangerous to "knock down" the blood pressure to normal values, because this can lead to circulatory disorders of the brain, sometimes irreversible.

You can also take sedative medications, for example Valocardin, to achieve normalization of the patient's excited psycho-emotional state, help him get rid of fear, panic and anxiety.

A person with hypertensive crisis before the doctor's arrival should not take all kinds of medications without an urgent need. This is an extremely unjustified risk. It will be more correct to wait for the arrival of a brigade of emergency ambulance, which will select the most suitable drug and be able to inject it. The same team of doctors, if necessary, can decide on hospitalization of the patient to the hospital or make a decision on his treatment out-patient, that is at home. After the relief of the hypertensive crisis is made, it is necessary to consult a cardiologist or therapist so that he can select the best antihypertensive drug for adequate treatment of hypertension.

After the hypertensive crisis

Consequences of the hypertensive crisis can be truly terrible. It can be irreversible changes in internal organs and systems, which in the future will necessarily affect the quality of life of the patient. For the purposes of normal living, in the future after an attack of a hypertensive crisis, it is necessary to observe prevention.

Prevention of hypertensive crises is a mandatory comprehensive exercise, it includes the following:

1. Continuous monitoring of blood pressure. It is necessary to take as a rule, regardless of the general state of health, to measure arterial pressure several times a day.

2. Taking medications to lower blood pressure, appointed by the treating doctor, for life. If you resort to such therapy, as well as once a month do not forget to visit your doctor, hypertensive crises in most cases can be prevented.

3. If necessary, try to avoid all stressful situations. To do this, you can also resort to some psychotherapeutic techniques( for example, hypnosis or autogenous training).It is necessary to include physical activity in your daily routine.

4. It is absolutely necessary to exclude nicotine and alcohol from their lifestyle. It is during their abuse that a sharp and persistent spasm of the blood vessels occurs, the consequences of which can be tragic very, very.

5. It is necessary to clearly control the weight, because patients with excess weight, as a rule, have an elevated sugar level in the blood, which at a hypertensive crisis threatens serious complications.

6. Nutritional diet for hypertensive crises should also be adjusted. Cooking salt is strictly forbidden to use, since it is in it that sodium, which retains water in the body. Medicinal preparations with hypertensive crises produce the most effective effect, if the diet is salt-free when hypertensive. Therefore, it is important to adhere to adequate rational nutrition in a hypertensive crisis.

Prevention of hypertensive crises in order mandatory is not necessary without control over the amount of fluid being drunk. Because blood pressure during hypertensive hypertension is excessive, fluid should not drink more than one and a half liters per day. Drinks that contain sodium should be excluded altogether. Diet in hypertensive crisis should be appointed by the attending physician, at best, a nutritionist.

Recovery after the hypertensive crisis is made in the mandatory, and according to the individual program for each individual patient.

If the patient is already on a stable bed rest, then they begin to conduct rehabilitation physical activities, which are designed to solve subsequent problems:

- balancing the patient's neuropsychic state;

- not a sharp accustomed to the physical stress of the human body;

- reduction of vessels of a tonus;

- improvement of the quality of the cardiovascular system

Recovery after a hypertensive crisis is mandatory includes individual and group sessions in medical and physical culture.