Hypertensive crisis: treatment at home and in hospital, first aid
The content of the article:
- Symptoms
- Diagnostics
- First aid at home for hypertensive crisis
- How to treat a hypertensive crisis
- Prevention of hypertensive crisis
- Video
Treatment of hypertensive crisis - a sharp and significant increase in blood pressure (BP), which is accompanied by severe clinical manifestations (from intense headache to loss of consciousness and multiple organ failure), is carried out according to the standards adopted by the international medical community (international protocol).
A hypertensive crisis is characterized by an acute rise in blood pressure
A distinctive feature of a hypertensive crisis is the speed of its development, it takes the patient by surprise. An important link in pathogenesis is the defeat of vital organs due to a violation of their blood supply, as well as acute vascular insufficiency. At the prehospital stage, the patient needs to provide first aid as soon as possible so that dangerous complications do not develop. It is imperative to call an ambulance, since full medical care can only be provided in a hospital.
Symptoms
There is no specific BP indicator that would indicate a hypertensive crisis. This figure is individual for each patient, and if the normal, so-called human working pressure is, for example, 100 to 60 mm Hg. Art., then a hypertensive crisis can begin already at 140 to 80 mm Hg. Art. Therefore, it is important to know your working pressure - this allows you to evaluate deviations from it.
The definition of a crisis is made according to the main symptoms. Usually, a crisis is preceded by a slightly increased pressure (hypertension), a person may complain of dizziness, a feeling of lack of air in the room. The crisis develops sharply, literally in a few minutes, and is characterized by a sharp deterioration in the patient's well-being. An individually high blood pressure level is recorded. The condition is accompanied by cerebral symptoms: darkening in the eyes, "flies" before the eyes, nausea, deterioration in visual concentration on specific objects, involuntary vibrations of the eyeball, fear of death, anxiety and panic. Cardiac symptoms reflect disorders in the work of the heart, which is subjected to significant stress during a crisis, as it belongs to the organs with the highest blood circulation. The patient feels distinct beats of the heart,interruptions in his work, long pauses between beats or, on the contrary, tachycardia (accelerated heart rate), chest pain can also join these signs. A hypertensive crisis can lead to myocardial damage.
It is categorically not recommended to treat a crisis at home.
Autonomic disorders have a wide range of manifestations, from pathological reflexes and violations of the peristalsis of the cavity organs, loss of appetite, to severe pathological hyperkinesia.
During a hypertensive crisis, the so-called shock organs, or target organs, are primarily affected. These are organs with intense blood circulation that maintain homeostasis, which is critical for the vitality of the body. These include the brain, heart, kidneys, liver. In addition, the retina has a high risk of damage. Thus, during an attack of hypertension, there is a violation of the functions of these organs, for example, the absence of diuresis as the main nephrological symptom, visual disturbances.
Depending on the degree of damage to target organs, a complicated and uncomplicated hypertensive crisis is distinguished. The first type, complicated, is characterized by an acute progressive lesion of shock organs and constitutes a direct threat to the patient's life, being an urgent terminal condition. If this type of disease is determined, you need to act immediately - the main task is to lower blood pressure within two hours. Complications can be arrhythmias, myocardial infarction, stroke, dissection of the aortic aneurysm.
The second type has a more favorable course, although it is a potential threat to life, since it can turn into a complicated one. In an uncomplicated crisis, shock organs are not affected, although they experience an increased load. This type of disease requires a gradual decrease in pressure over 24 hours. The clinical picture of an uncomplicated crisis is usually less pronounced.
Diagnostics
The main method for diagnosing a hypertensive crisis is measuring blood pressure and comparing it with a worker. When measuring blood pressure, attention is paid to the individual indicators of systolic and diastolic pressure. If cardiac output increases and prevails over peripheral vascular resistance, such a crisis is called hyperkinetic - its cause lies in the heart. If the systolic pressure does not change or a decrease is observed, and the diastolic pressure increases, then the pressure increases due to peripheral vascular resistance and, most likely, the cause of the pathological condition in the kidneys. The eukinetic type is characterized by an increase in two numbers, its etiology may be different.
First aid at home for hypertensive crisis
It is impossible to produce a full-fledged treatment of a hypertensive crisis at home - the condition requires immediate hospitalization, so the first step is to call an ambulance. However, how to treat hypertension before a doctor arrives?
Without understanding whether the crisis is complicated or not, full treatment cannot be carried out, it is necessary to adhere to the general first aid algorithm:
- Lay the patient on his back, remove excess clothing and shoes from him, open the windows in the room, exclude additional irritants in the room where the patient is located - loud sounds, bright light.
- Measure blood pressure and write down the data, this information will be needed by doctors. Measurement of blood pressure should be carried out every 10 minutes before the arrival of an ambulance.
- Assess the patient's condition, in particular his consciousness. To do this, you should ask a few simple questions and see if the patient finds it difficult to answer. If there are suspicions that the patient is in an altered state of consciousness (cannot answer the question, cannot concentrate, cannot pronounce the answer clearly), one can suspect a complicated crisis.
- You can take a pharmacological drug to lower blood pressure, orally or sublingually. These include Nifedipine, Clonidine, Captopril, Metoprolol, Prazosin, Furosemide, Torasemide. It is necessary to choose one of the drugs in each group, and it is not recommended to take more than three different names at a time. For example, it can be Captopril as an ACE (angiotensin converting enzyme) inhibitor and Furosemide as a diuretic. Constant monitoring of the pressure level ensures the safety of drug intake.
- After the arrival of the ambulance, the doctor should be sure to provide information on the blood pressure indicators and inform which drugs and in what dose were taken by the patient.
When the ambulance arrives, it is necessary to answer the questions specified in the protocol as accurately as possible. It is necessary to indicate the exact time of the onset of the crisis, its duration, what is the reason for the occurrence of a pathological condition (emotional stress, stress, physical labor), whether such conditions have occurred before.
During the collection of anamnesis, the doctor will be interested in what medications the patient takes daily, what means they stopped the hypertensive crisis before the ambulance arrives, what risk factors are observed in a particular patient (smoking, diabetes mellitus, atherosclerosis). An electrocardiogram is then taken to check for possible organic damage to the heart. It is also desirable to monitor the oxygen saturation in the blood (pulse oximetry).
How to treat a hypertensive crisis
In a complicated crisis, the main task is to reduce blood pressure and minimize damage to target organs.
With hypertensive encephalopathy, it is necessary to reduce blood pressure by 25% within 8 hours. For this, a solution of magnesium sulfate (magnesia) is introduced, droppers with Furosemide or Labetalol are used, which help to reduce the volume of circulating blood, and, accordingly, its pressure on the walls of blood vessels.
Acute coronary syndrome is the second most common, but the first most dangerous complication of hypertensive crisis. In this case, the goal of therapy is to reduce pressure by 20-30% and improve myocardial circulation. Nitroglycerin is prescribed to dilate the coronary vessels and diuretics to reduce blood volume. If the condition worsened and developed into an acute failure, then in addition to nitroglycerin and diuretics, Enalaprilat and Urapidil are prescribed intravenously.
To stop arrhythmias, beta-blockers, sodium nitroprusside in a dropper, as well as the above drugs in the form of supportive therapy are used.
If a hypertensive crisis is complicated by myocardial infarction or stroke, the priority remains to lower blood pressure, in parallel with this, treatment of secondary pathology begins. In case of a heart attack, drugs are administered that increase the endurance of the myocardium in conditions of hypoxia, angioprotectors; with a stroke, cerebroprotectors and drugs that improve cerebral circulation are used.
Prevention of hypertensive crisis
If a person is aware of the presence of hypertension, active prevention of hypertensive crisis should be carried out. It proceeds from the reasons - it is necessary to avoid emotional stress, hard physical labor, adjust sleep patterns, and normalize body weight. Moderate physical activity, physiotherapy exercises are shown.
It is imperative to quit bad habits, especially smoking. Constant spasms of vascular smooth muscles lead to wear and tear, due to which the vascular system cannot compensate for cardiac output. In addition, smoking can directly provoke a hypertensive crisis.
It is worth excluding food and drinks that affect blood pressure from the diet. This means rejection of salt or its significant limitation, rejection of spicy and spicy foods, tonic drinks. It is recommended to consume food in small portions regularly throughout the day, while gentle heat treatment is desirable, it is better to exclude fried foods from the menu.
Regular blood pressure measurements should become a mandatory habit for patients - sometimes the crisis does not manifest itself clinically, but the pressure readings are significantly higher than normal. To exclude a secondary mechanism for the development of hypertension, you should visit an endocrinologist and nephrologist.
As a way of prevention, and not a fundamental treatment, folk remedies are suitable. Often they resort to decoctions of medicinal herbs - you can slightly reduce the pressure with the help of an infusion of viburnum or a decoction of wild rose. Mild sedatives are also suitable for daily use - a decoction of chamomile, valerian, peppermint, motherwort.
Rosehip decoction acts as a mild diuretic, thereby lowering blood pressure
One of the popular and widely advertised means of treating hypertension is the so-called Mishin coils. The inventor claims that this device generates an electromagnetic field of high frequency, which produces a tonic biological effect on blood vessels. However, there is no official proof of the effectiveness of this method, and the safety profile has not been established either.
Video
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Nikita Gaidukov About the author
Education: 4th year student of the Faculty of Medicine No. 1, specializing in General Medicine, Vinnitsa National Medical University. N. I. Pirogov.
Work experience: Nurse of the cardiology department of the Tyachiv Regional Hospital No. 1, geneticist / molecular biologist in the Polymerase Chain Reaction Laboratory at VNMU named after N. I. Pirogov.
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