Hypertensive crisis: symptoms, signs, treatment
The content of the article:
- Causes of a hypertensive crisis
- Hypertensive crisis - what is it?
- Signs of a hypertensive crisis
- First aid for hypertensive crisis
- Diagnostics
- Treatment
- Forecast
- Rehabilitation and prevention
- Video
Hypertensive crisis is a pathological condition in which a sudden critical increase in blood pressure (BP) occurs, accompanied by a sharp deterioration in health. This is the most common reason for calling an ambulance in adults. ICD-10 code - I10.
Why is a crisis dangerous? The emergence of life-threatening complications: stroke, acute heart failure, myocardial infarction, pulmonary edema, dissecting aortic aneurysms, acute renal failure.
In both complicated and uncomplicated crises, the patient requires urgent medical attention.
Causes of a hypertensive crisis
The immediate cause of the crisis is a sudden and significant rise in blood pressure. As a rule, it is preceded by long-term high blood pressure, however, in some diseases, a crisis may occur against the background of normal blood pressure values.
In 30% of cases of hypertension, crises are observed, and they can occur even at the initial stage of hypertension, 1-2 degrees.
In addition to hypertension, pathology can develop against the background of the following diseases:
- damage to the kidneys and their blood vessels (as a complication of pyelonephritis, glomerulonephritis, nephroptosis, nephropathy of pregnancy, diabetic nephropathy);
- endocrine diseases (systemic lupus erythematosus, pheochromocytoma, Itsenko-Cushing's syndrome);
- atherosclerotic lesions of the aorta and its branches;
- discontinuation of antihypertensive drugs;
- severe burns, craniocerebral trauma;
- taking amphetamine and cocaine;
- neoplasms of the brain.
Risk factors include excessive physical exertion, frequent stress, hypothermia, meteorological dependence, alcohol abuse, metabolic disorders, in women - menopause.
Hypertensive crisis - what is it?
A crisis can have a neurovegetative, edematous and convulsive form, be complicated and uncomplicated.
In a crisis with a predominance of neurovegetative syndrome, a significant release of adrenaline occurs, which is usually caused by mental overstrain.
The edematous form of crisis is more characteristic of overweight women against the background of an imbalance in the renin-angiotensin-aldosterone system.
A convulsive crisis is caused by a dysregulation of the tone of small-caliber cerebral arteries against the background of a sharp increase in blood pressure.
The uncomplicated form develops more often in relatively young patients. Complicated crisis occurs much less frequently, is characteristic of patients with severe concomitant diseases or a long history of hypertension, and is characterized by damage to target organs. Depending on localization, complications are divided into vascular, cardiac, cerebral, renal, ophthalmic.
According to the mechanism of increasing blood pressure, the following types of crisis are distinguished:
- hypokinetic - a decrease in cardiac output and a sharp increase in the resistance of blood vessels, while diastolic pressure mainly increases; observed mainly in elderly patients with severe cerebral symptoms;
- hyperkinetic - an increase in cardiac output with normal or decreased tone of peripheral blood vessels, while there is an increase in systolic pressure;
- eukinetic - occurs with normal cardiac output and increased tone of peripheral blood vessels, while both systolic and diastolic pressure can increase.
Signs of a hypertensive crisis
How does the disease manifest itself? Patients experience severe headache, which is accompanied by nausea, sometimes vomiting, lethargy, tinnitus, visual impairment, sensitivity and thermoregulation, excessive sweating, and heart rhythm disorders.
A neurovegetative crisis is characterized by nervousness, flushing of the skin of the face and neck, tremors of the upper extremities, dry mouth, increased sweating. High-intensity headache is localized in the temporal or occipital region, or is diffuse in nature. Also, patients complain of noise in the ears or head, visual disturbances (flashing of flies and / or veils in front of the eyes), frequent urination (while a large amount of light urine is released), numbness of the limbs, a feeling of tightness and burning of the skin, a decrease in tactile and pain sensitivity. Determined by the acceleration of the heart rate, the increase in pulse pressure. The duration of an attack is usually 1–5 hours, and the patient’s life is usually not threatened.
With the edematous form of pathology, the headache is less pronounced, there is apathy, depression, drowsiness, disorientation in space and time, pallor of the skin, swelling of the eyelids and fingers of the upper extremities, puffiness of the face. The crisis is usually preceded by muscle weakness, extrasystoles, decreased urine output. The attack lasts from several hours to several days and has a relatively favorable course.
The main sign of a hypertensive crisis is intense headache against the background of a general deterioration in well-being
The convulsive form has the most severe course. It is characterized by cerebral edema, which can last up to several days (usually 2-3 days), characteristic of patients with kidney pathology. Patients have tonic and clonic seizures, loss of consciousness, amnesia. Often complicated by intracerebral or subarachnoid hemorrhage, paresis, coma, disability and death of the patient are possible.
Once the crisis has developed, it tends to recur. Damage to target organs can occur both at the height of the crisis and with a rapid decrease in blood pressure.
First aid for hypertensive crisis
At the first sign of a crisis, an ambulance should be called immediately. Before her arrival, the patient must be given first aid. He should be calm, seated or laid in such a way that his head is raised, provide fresh air (open windows in the room, loosen tight clothes). Measure blood pressure, and then measure every 20-30 minutes, record the results, which will need to be reported to the doctor. If the patient has already been prescribed one or another antihypertensive drug, take an extra dose of the drug. With strong nervous excitement, you can take a sedative (tincture of valerian, motherwort, Corvalol, Valocordin, etc.).
What should not be done in the first aid? You can not quickly lower the pressure - this can lead to myocardial infarction. In addition, it is impossible to independently give the patient drugs that are not prescribed by a doctor, even on the basis that they once helped other people.
Diagnostics
It is possible to suspect the occurrence of a crisis when the blood pressure level rises above the individually tolerated values against the background of suddenly appeared clinical signs of a vegetative, cardiac, cerebral nature. Blood pressure should be measured several times at intervals of 15 minutes (first on both hands, and then on the arm where the reading was higher). Blood pressure in patients with crisis can increase to varying degrees (usually the systolic is above 170, and the diastolic exceeds 110 mm Hg). Establishment of high blood pressure in combination with a characteristic clinical picture is sufficient for initial diagnosis and the beginning of medical care; further examination, if necessary, is carried out after the relief of acute symptoms of the crisis.
In the course of physical diagnostics, tachycardia or bradycardia, extrasystole, hard breathing, moist wheezing in the lungs are determined.
Of the instrumental methods, electrocardiography is usually used. When decoding an electrocardiogram, the presence of cardiac arrhythmias, conduction disturbances, as well as focal changes and left ventricular hypertrophy are taken into account.
In some cases, echocardiography, electroencephalography, rheoencephalography, 24-hour blood pressure monitoring may be necessary. Magnetic resonance imaging may be required to rule out stroke.
From laboratory tests, a general blood and urine test, a biochemical blood test and others according to indications (for example, a coagulogram) are prescribed.
The patient is referred to an ophthalmologist for the purpose of ophthalmoscopy (with hypertension, a symptom complex of stagnant fundus is revealed). You may also need to consult a cardiologist, nephrologist, endocrinologist and other specialists.
Treatment
With an uncomplicated form of hospitalization, treatment is carried out at home, with the development of complications, treatment is carried out in a hospital, but begins at the pre-hospital stage. Non-stopping, as well as repeated crises and the need for additional research to clarify the diagnosis are also indications for hospitalization of the patient in the clinic's hospital. The choice in favor of a particular therapy regimen depends on the etiological factor and the form of the crisis.
In the event of a critical increase in the level of blood pressure, the patient is assigned to bed rest, rest, adherence to a diet.
Drug therapy is aimed at normalizing blood pressure, protecting target organs, stabilizing the cardiovascular system and eliminating the symptoms of a hypertensive crisis.
The decrease in blood pressure must be smooth, otherwise it can lead to myocardial infarction or stroke
Calcium channel blockers, angiotensin-converting enzyme inhibitors, beta-blockers, vasodilators are used to lower blood pressure. It is important to ensure a gradual decrease in blood pressure (approximately 25% from the baseline value within the first hour, decrease to normal values within 2-6 hours), as too rapid a decrease in blood pressure increases the risk of acute vascular complications.
Symptomatic treatment may include oxygen therapy, use of cardiac glycosides, diuretics, antiarrhythmic drugs, analgesics, anticonvulsants, antiarrhythmics, and antiemetics. Mustard plasters, foot baths, and hirudotherapy can be used as additional symptomatic remedies.
Forecast
The prognosis for a crisis depends on the presence and type of complications, the timeliness and effectiveness of treatment and rehabilitation. With timely diagnosis and adequate therapy, the prognosis is conditionally favorable - it is possible to stabilize blood pressure and avoid the development of severe complications, however, as a rule, it is not possible to completely cure the disease.
Stroke, myocardial infarction or other acute circulatory disorders can cause death in the setting of a crisis.
Rehabilitation and prevention
For the purposes of primary prevention, as well as to prevent the development of adverse consequences of a hypertensive crisis, it is necessary to timely treat diseases that can lead to pathology, control and normalize blood pressure levels in time, give up bad habits, control body weight, avoid stress, lead an active lifestyle, adhere to the principles of healthy eating. Patients suffering from hypertension should limit the consumption of table salt (no more than 5 g per day), refuse foods containing large amounts of salt, heavy, fatty foods, tonic drinks. It is necessary to observe the regime of work and rest, a good night's sleep is especially important.
Video
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
