Hypertensive crisis or hypertensive emergency is a sudden rise in blood pressure to levels greater than 200/130 mmHg. The disease must be treated immediately, otherwise it can turn into a life-threatening hypertensive emergency.
What is hypertensive crisis?
Headaches, shortness of breath and pain in the chest are typical of the disease. This is usually accompanied by nausea and vomiting, nosebleeds or dizziness. See AbbreviationFinder for abbreviations related to Hypertensive Crisis.
A hypertensive crisis is a sudden high rise in blood pressure. A distinction is made between hypertensive crisis and hypertensive emergency. Both have blood pressure values higher than 200 mmHg systolic and/or 130 mmHg diastolic.
While a hypertensive crisis is not life-threatening because no organ damage is caused, the hypertensive emergency is a complication. The high blood pressure can cause damage to organs, cerebral hemorrhage, a stroke or a heart attack.
The hypertensive crisis always harbors the risk of developing into a hypertensive emergency. The sudden increase in blood pressure is one of the most common medical emergencies; approximately a quarter of these patients are suffering from a hypertensive crisis or hypertensive emergency. Women are affected much less often than men.
Various circumstances can be considered as causes of a hypertensive crisis. High blood pressure (primary hypertension) often already exists, but is not treated as prescribed by the doctor.
The patients do not carry out the therapy consistently, medication is not taken regularly, alcohol is consumed in excess despite the high blood pressure, drugs, especially stimulating amphetamines, are consumed or the diet remains too rich and rich.
Stress in the presence of high blood pressure can also trigger a hypertensive crisis. Another cause can be high blood pressure in women during pregnancy, the hypertensive crisis is referred to here as eclampsia. Kidney diseases and hormonal disorders also lead to increased blood pressure, which can lead to a hypertensive crisis.
Symptoms, Ailments & Signs
A hypertensive crisis can cause a whole range of symptoms and complaints, which can occur in different types and degrees. Headaches, shortness of breath and pain in the chest are typical of the disease. This is usually accompanied by nausea and vomiting, nosebleeds or dizziness. The increased blood pressure can also cause neurological disorders such as impaired perception or paralysis.
If the hypertensive crisis is not treated promptly, the high blood pressure sometimes causes irreversible damage to the organs. Externally, the disease manifests itself in a very red head, outbreaks of sweat and protruding veins on the neck and arms. Many of those affected also tremble or suffer from convulsions, which increase in intensity as the disease progresses and are sometimes associated with pain.
A hypertensive crisis can provoke a heart attack or circulatory collapse . A heart attack is initially manifested by a rapid increase in chest pain, accompanied by numbness in the right arm and difficulty swallowing. A circulatory collapse can occur quickly in the hypertensive crisis – there is initially a slight disturbance of consciousness, which quickly develops into dizziness and brief moments of unconsciousness. If no immediate treatment is given, the patient will become unconscious and there is an acute risk of death.
Diagnosis & History
Hypertensive crisis symptoms can vary in severity. Older people who have had high blood pressure for a long time can often tolerate the sudden increase in blood pressure better than young people who normally have low blood pressure.
They usually have the more severe symptoms. Typical complaints are headaches, shortness of breath, chest pain, nausea, nosebleeds, vomiting or blurred vision. Some sufferers experience neurological disorders such as numbness or sensory disturbances. Confused states also occur.
For the emergency doctor, it is initially not important whether a hypertensive crisis or already a hypertensive emergency is present. If an extremely high blood pressure is measured, it must be lowered slowly and immediately in both cases. In the further course, he then receives additional information by asking about the symptoms and the history of the disease.
Other examinations such as blood and urine tests, EKG (measuring the heartbeat), X-rays of the lungs, computer tomography (CT) of the head, neurological examinations and the reflection of the fundus are among the usual methods when a hypertensive crisis is suspected.
This crisis can lead to a life-threatening condition for the patient, so that immediate treatment is necessary. In the worst case, the person affected can die from the symptoms of this crisis. The sharp rise in blood pressure usually causes headaches and a very red head. Those affected continue to suffer from vomiting and severe nausea.
The patient’s resilience also drops enormously and normal activities can no longer be carried out easily. Those affected suffer from paralysis and numbness that can spread throughout the body and may continue to lose consciousness. It is not uncommon for chest pain to occur, which can lead to a heart attack.
Not infrequently, patients also suffer from nosebleeds and blurred vision. A general sophistication of the patient occurs, which reduces the quality of life. The treatment is carried out with the help of medication and aims to lower blood pressure.
Complications and irreversible damage can then occur if the blood pressure is lowered too quickly. Furthermore, treatment of the underlying disease is also necessary to prevent this crisis in the future. This may also reduce life expectancy.
When should you go to the doctor?
Immediate action is required in the event of sudden high blood pressure. If there is severe internal heat, tachycardia, sweating, restlessness and reddening of the skin, an ambulance should be called immediately or a hospital should be consulted. If the symptoms are not due to immense physical or sporting exertion, the person concerned needs help. Since the hypertensive crisis can lead to loss of life without immediate medical care, an emergency service must be alerted. A feeling of pressure inside the body, tensing of muscles and tendons and nervousness are warning signs of the organism. If treatment is not initiated as soon as possible, lifelong consequential damage can occur in addition to death.
Paralysis or failure of individual functions is possible. A survivor of a hypertensive crisis typically requires daily care and support to cope with everyday life. If you have a headache, shortness of breath or difficulty breathing, call a doctor. Nausea and sudden vomiting are other signs of discrepancy. The affected person must be examined as soon as possible for sensory disorders, tingling in the limbs or numbness. Persistent stress or periods of emotional challenge can be the cause of the existing physical problems. A visit to the doctor is therefore recommended as soon as the person concerned has blood pressure problems for a long period of time.
Treatment & Therapy
A hypertensive crisis requires urgent medical attention lest it degenerate into a hypertensive emergency. This represents an acute, life-threatening emergency that must be treated immediately by an emergency doctor.
In the event of an emergency, therapy begins on the spot and continues during transport to the clinic. Blood pressure must be lowered immediately, but only slowly. The reduction in pressure in hypertensive emergencies must be monitored in intensive care so that it does not happen too quickly. If the blood pressure drops too quickly, the organs and especially the brain cannot process it, bleeding and irreversible damage would occur.
In the hypertensive crisis, it is also necessary to lower the blood pressure slowly. However, this treatment can also take place at home with medication in tablet form, while in hypertensive emergencies the antihypertensive substances must be administered by infusion. In addition, the patients receive medication that promotes water excretion (diuretics). Finally, once blood pressure has returned to normal, the underlying condition, if any, must be treated to avoid recurrence of hypertensive crisis.
Outlook & Forecast
The prognosis of a hypertensive crisis or a hypertensive emergency depends on the speed with which the patient can receive adequate medical care. The sooner intensive medical care is possible, the better the chances of a good prognosis. Full recovery is possible under optimal conditions. In many cases, a few minutes make the difference in the further development of the patient’s health.
If medical care is provided too late or not at all, the risk of the patient dying prematurely increases significantly. Alternatively, permanent functional disorders of various systems in the organism can be expected, which lead to a severe impairment of the general quality of life. Only rarely can a subsequent alleviation of the existing symptoms be documented without medical help in an emergency situation.
The reason for this is that the administration of medication leads to a reduction in blood pressure within a short period of time. If it does not occur, the blood pressure continues to rise and leads to the bursting of the blood vessels. The medication is necessary to stabilize the patient. In addition, a controlled lowering of the blood pressure is required so that there are no further complications. If this is successful, a further treatment and therapy plan can be drawn up. This usually provides for the elimination of the trigger of the hypertensive crisis or the necessary change in the current living conditions.
Since a hypertensive crisis usually occurs when high blood pressure already exists, you can definitely prevent it by treating the high blood pressure consistently, paying attention to a healthy diet, avoiding stress and getting enough exercise. Regular blood pressure monitoring is also helpful, especially in the case of existing underlying diseases that cause the symptom of high blood pressure.
After a hypertensive crisis, it is important to check blood pressure regularly. In the case of a hypertensive emergency, close monitoring (at least once every 30 minutes) must be carried out during aftercare. In order to prevent a further derailment of blood pressure and the associated strain on the cardiovascular system, underlying hypertension should be treated permanently with the help of drug therapy.
The selection of the medication and the desired values depend on the age and concomitant diseases of the person concerned. The aim of the therapy is a continuous reduction in blood pressure. Likewise, a survey of existing risk factors should be carried out in order to minimize the risk of blood pressure escalating again. Non-drug measures can be found in adhering to a special nutrition plan. A healthy, low-salt diet (maximum six grams of table salt per day) is desirable.
Plenty of fruit and vegetables and a simultaneous reduction in certain foods (e.g. saturated fatty acids, which are increasingly found in foods of animal origin) should be eaten. Substances that have a negative effect on the cardiovascular system should also be avoided. It is advisable to avoid alcohol, coffee and nicotine in general. In obese patients, normalization of body weight must be aimed for. Regular endurance sports are also recommended.
You can do that yourself
The hypertensive emergency, but also the hypertensive crisis, is a potentially life-threatening emergency. In any case, this must be treated by a specialist. In the acute situation, those affected can primarily ensure that they remain calm. Relaxation exercises can be used to try to have a positive influence on high blood pressure.
After the acute phase, the focus is primarily on prophylactic measures that can minimize the risk of another crisis. It is particularly important to take the prescribed antihypertensive medication regularly and correctly. Only reliable intake enables a permanent reduction in blood pressure.
In the long term, those affected should aim to change their lifestyle. This includes weight reduction, preferably through a Mediterranean diet with lots of light fish, vegetables and olive oil. It is also advisable to keep the salt content in the food low. Smoking, alcohol and excessive caffeine consumption should be completely avoided. Regular exercise and light endurance sports for at least 30 minutes three to five days a week can also reduce high blood pressure and thus the risk of a hypertensive crisis. excessive stressrepresents a possible trigger for a blood pressure crisis, so it is important to avoid stress in everyday life and at work if possible.