Author of the article: Strokina OA, internist, cardiologist, functional diagnostics.
June 2019.
Synonyms: hypertensive crisis, pressure surge.
ICD-10 code: basic disease - hypertension I.10-I.13 or secondary hypertension I.15.
Hypertensive crisis - a sudden increase in blood pressure. Development of crisis is accompanied by symptoms such as sudden headache, ringing in the ears, blurred vision, feeling of heat, redness of the face. Crisis diagnostics based on clinical symptoms and blood pressure measurement. Drug treatment only.
Hypertensive crisis - a sharp rise in blood pressure: Systolic above 180 mm. Hg. Art. and / or diastolic above 120 mm. Hg. Art. But sometimes it develops at lower values. The basis of the diagnosis in this case are greater clinical symptoms.
Prevalence
In Russia, about 40% of the population has high blood pressure. Among these people, about 1-5% annually suffer hypertensive crisis. Most of the passes in an easy manner, that is, without complications. However, 25% of patients suffer from crisis development of complications such as myocardial infarction, acute heart failure, pulmonary edema, hypertensive encephalopathy, stroke or cerebral infarction, aortic dissection, eclampsia (a condition in pregnant women with threatened miscarriage) - complicated hypertensive crisis.
Select the age at which most often occur hypertensive crises is almost impossible. They occur in young to 30 years, and in the elderly 80. Greater importance here are the comorbidities and body condition, such as pregnancy, stress as risk factors.
Causes of
Hypertensive crisis develops mainly due to hypertensive disease, Or as it is called essential or primary hypertension.
Less common cause of exacerbation becomes the secondary hypertension. It develops as a result of the following diseases:
- Pathology of the kidney and blood vessels (pyelonephritis, glomerulonephritis, polycystic kidney disease, diabetic nephropathy, renal artery stenosis, etc.);
- Pheochromocytoma - a tumor of the adrenal glands that produces a large amount of adrenaline, which increases the pressure.
- Primary aldosteronism (Conn syndrome) - congenital adrenal disease.
- Syndrome and disease Cushing's.
- Coarctation (luminal narrowing) of the aorta.
- Hyperthyroidism (excessive production of thyroid hormones).
- Dosage forms of hypertension: chronic administration of glucocorticoids (prednisolone), non-steroidal anti-inflammatory drugs (indomethacin, naproxen, diclofenac).
Who is at risk
For cardiovascular disease, in particular for the development of hypertensive crisis is characterized by common risk factors:
- male gender
- age over 50 years;
- family history;
- smoking;
- poor nutrition;
- obesity;
- low physical activity;
- the presence of snoring and breathing stops during sleep episodes.
There are common triggers a sudden rise in blood pressure:
- stopping preparations reducing pressure;
- stress;
- surgery;
- excessive intake of salt and liquid;
- hormonal contraceptives;
- alcohol abuse.
Also produce reflex factors contributing to a sharp rise in blood pressure:
- pain;
- anxiety;
- acute disorder of urination with prostate cancer or urolithiasis;
- sleep apnea (cessation of breathing) in a dream.
The frequency of pressure shocks depends on several factors:
- Firstly, this commitment therapy (regular intake of properly chosen treatment regimen) and correction of lifestyle: weight loss, nutrition with low in fat, salt, increase in the proportion of plant foods diet, smoking cessation, alcohol, reduce the amount of stress. possibly changing jobs.
- Secondly, by timely treatment of underlying disease - a disease or idiopathic causes or secondary arterial hypertension (renal disease, adrenal syndrome and Cushing's disease, hyperthyroidism and others).
- Thirdly, the important reason for the high frequency of hypertensive crises is Genet.
types of crises
There are many classifications of hypertensive crisis. In general, they are associated with clinical symptoms.
First of all doctors use the separation of the pathological process by the presence of complications:
1. Complicated hypertensive crisis is also called the emergency, life-threatening. Patients develop acute damage to target organs (heart, brain, kidneys, eyes), sometimes leading to fatal consequences - death. A person with such views kriza admitted to hospital intensive care unit for emergency pressure reduction. Complications of hypertensive crisis also include a sharp increase in blood pressure in pre-eclampsia, eclampsia in pregnant women, brain injury, drug-taking.
2. Uncomplicated hypertensive crisis characterized by the appearance of minimal symptoms in the face of high pressure without the development of target-organ lesions. Emergency hospitalization is required.
Also secrete classification Golikova.: AP
- hyperkinetic embodiment crisis when increases predominantly systolic (upper) pressure, the pulse pressure (the difference between systolic and diastolic) is increased in patients with the frequently observed increased frequency palpitations;
- hypokinetic crisis - increasing diastolic (lower) blood pressure decrease the difference between systolic and diastolic pressures, the tendency to bradycardia (slowing heartbeat);
- eukinetic crisis - Mixed embodiment, and is characterized by an increase in systolic and diastolic pressure. It can develop as tachycardia, bradycardia and the like.
The options listed above correspond to clinically hypertensive crisis to another classification:
Adrenal crisis type I
Hypertensive crisis type 1 - adrenal. It is evolving quickly, suddenly, without warning. Characterized by headache, feeling hot, ripple and shiver throughout the body, redness of the skin, sweating. It is rapid - from a few minutes to several hours. Hyperkinetic variant corresponds to the development of a crisis.
Noradrenaline crisis type II
Characterized by the gradual development, severe, long duration - from several hours to several days.
Patients complain of a sharp headache, hearing and visual impairment, who are on their own, sometimes transient (Being alone) violation of the motor capacity of extremities, confusion, squeezing, pressing pain in the heart. Meets hypokinetic variant of crisis.
complicated crisis
It is characterized by an acute coronary insufficiency, pulmonary edema, or acute stroke as a stroke.
symptoms
Hypertensive crisis depending on its type lasts from several minutes to hours (adrenal, type 1), to several days (NE, type 2).
Prodromal symptoms (precursors crisis) at elevated pressure does not exist. Most often, patients immediately feel the symptoms are already under increasing pressure. Therefore, to predict the development of the crisis is almost impossible.
Hypertensive crisis - a sharp rise in blood pressure: Systolic above 180 mm. Hg. Art. and / or diastolic above 120 mm. Hg. Art. But sometimes it develops at lower values. The basis of the diagnosis in this case are greater clinical symptoms.
The elderly often during a hypertensive crisis increases the upper, systolic blood pressure, while the lower, diastolic may be either normal or increased, but to a lesser degree.
In 70-90% of patients with hypertensive crisis revealed the so-called triad of symptoms:
- headache, advantageously in the occipital part;
- dizziness;
- nausea.
A few less common symptoms:
- crushing chest pain, squeezing character;
- dyspnea;
- neurological symptoms (impaired hearing, vision, limb movements, sensitivity of the skin, loss of consciousness, etc.);
- psychomotor agitation;
- nosebleeds.
During a sharp increase in blood pressure may also develop autonomic symptoms:
- muscle tremors;
- red spots on the skin;
- sweating;
- palpitations;
- the end of the crisis increased urination;
- sometimes loose stools.
Diagnostics and how to measure the pressure correctly
Diagnosis hypertensive crisis based on blood pressure measured with a tonometer. There are automatic, poluavtomaticheksie and mechanical sphygmomanometers. The most accurate measurement can only boast of a mechanical. However, it is not always easy to use.
It is worth noting that there are certain rules for blood pressure measurement:
- Before blood pressure measurement of a person must breath and calm down.
- Sit comfortably and conveniently, the legs do not cross.
- The hand is on the table at heart level.
- The cuff is applied on the shoulder. Its lower edge is 2 cm above the shoulder crease.
Photo: correct position of the cuff on the arm when measuring pressure
- Measured pressure on both hands.
- Where the maximum pressure on the hand pressure is measured 2 more times.
- An average is taken of the outcome.
Between the measurements should be made at intervals of 1-3 minutes.
When you call the team ambulance patient also compulsorily withdraw electrocardiogram to rule out more serious problems with the heart. However, in hypertensive crisis complicated by acute coronary syndrome, by electrocardiography revealed quite clear criteria for myocardial ischemia, which can grow in the future in heart attack. on the ECG changes may also occur during the development of acute stroke.
Research Methods in complicated Stroke:
- Computer tomography or magnetic resonance imaging of the brain when advised by stroke development, CT with contrast aorta in breast and abdomen with its bundle.
- echocardiography - in acute coronary syndrome, acute heart failure.
First aid
At home, help a person with high blood pressure is usually possible. It is important to reduce the pressure gradually.
Important! Acceptable reduction of blood pressure by 25% from baseline after 2 hours and not more. Otherwise, the big risk of failure of the brain blood circulation, heart.
Today, there are only 3 drugs, coping with the problem:
- Captopril (Capoten), 25 mg per tablet. When Stroke is taken under the tongue usually start with half tablet. The drug will work in 15-20 minutes. With the ineffectiveness in 30 minutes you can take even half a tablet. And then wait for the arrival of emergency medical care.
- Nifedipine (Corinfar, Kordafleks) 10 mg per tablet. During a crisis, you can take 10 mg of the drug under the tongue. The action begins in 20 minutes. Repeated reception is undesirable. With the ineffectiveness - we expect an ambulance.
- Moxonidine (Fiziotenz) at a dosage of 0.2, 0.3 and 0.4 mg. With the development of hypertensive crisis moxonidine is not a first-line drug. It is used in patients who do not help captopril and nifedipine or there are contraindications to their use. Moxonidine is taken in a dosage of 0.2 mg orally. The effect comes in 1-2 hours.
In addition to the drug, with no effect on them for an hour can also help hot foot bath having a water temperature of about 40 degrees or overlay mustard plasters on gastrocnemius muscles. However, should not be used at the same time both are ways to reduce blood pressure.
The young target level of blood pressure reduction - less than 140/90, and preferably even lower, down to 120/80. In elderly and with an increase in the upper and lower pressure target level is the same. If only systolic increases, then it must reduce to a level below 150 mm Hg. Diastolic blood pressure in this case should not be less than 60-70 mm Hg.
After lowering of blood pressure a person may feel weak. The best option for recuperation will be a dream. It is not necessary to continue to work or to engage in any physical activity, as this could trigger a second crisis. Usually, the next day the patient feels better already, but if any of the symptoms persist, it is best to call the local therapist or an ambulance.
Hypertensive crisis can go on their own. But it is unknown whether it will be as painless for the individual. Every crisis - is stressful for the body, which anyway is gradually changing the structure of blood vessels. In any case it is best at elevated pressure to take medication and avoid potential effects - myocardial infarction, stroke, aortic dissection, which can lead to fatal outcome.
medical care
An ambulance should be called in the following cases:
- if for one hour treatment at home does not reduce the pressure;
- chest pain, not passing nitroglycerin;
- feeling of heart rhythm disturbances, disruptions in its work;
- visual impairment, hearing;
- decrease in sensitivity, numbness of the extremities, face;
- violation of the motor function of limbs.
Uncomplicated hypertensive crisis is treated at home by the patient or ambulance crews. Reduced blood pressure is not more than 25% of baseline within 2 hours via captopril, nifedipine or moxonidine. Hospitalization is recommended only in case of complicated hypertensive crisis or suspected secondary hypertension character.
Treatment of complicated hypertensive crisis held in intensive care, intensive care or cardiology therapeutic department. When a stroke is suspected, the patient is transferred to the ICU (intensive care unit) Neurology.
The pressure decreases also not too fast - not more than 25% from baseline for 2 h. For this purpose, the intravenous administration of drugs:
- nitroglycerine or sodium nitroprusside;
- ACE inhibitors (enalaprilat);
- beta blockers (metoprolol, esmolol);
- alpha blockers (phentolamine);
- diuretics (furosemide);
- neuroleptics (droperidol).
After stabilization of the pressure level and returning it to normal values should be reviewed antihypertensive therapy may add to or change any medication. It all takes place in an outpatient setting. because the selection of therapy - a lengthy process takes from a week to several months.
In the intensive care ward or intensive care patients with hypertensive crisis lie before the stabilization and removal of acute symptoms. When the doctor on the results of the survey determines that the patient's life is not in danger, a person translates into a therapeutic, cardiological or neurological separation depending on the presence complications.
It so happens that patients are in intensive care for several weeks and the doctors can not cope with high blood pressure. But basically it is patients who have severe comorbidities: diabetes, kidney failure, thyroid disease, heart rhythm disturbances.
The rehabilitation process depends from the ensuing complications. In stroke rehabilitation is very long, it includes not only gradual recovery of lost or damaged functions, but and physiotherapy, massage to prevent joint mobility restrictions and the normalization of muscle tone. Myocardial infarction - a gradual expansion of physical activity.
Complicated hypertensive crisis
Hypertensive crisis - a condition which runs in time and complicated or not will become clear after some period of time during which it is necessary as soon as possible take measures to reduce the level of blood pressure. The only way to prevent complications of hypertensive crisis, especially in hypertension.
In some secondary hypertension crises are automatically considered complicated, and the patient immediately admitted to the hospital as to cope with high blood pressure at home is almost impossible. Such conditions include pheochromocytoma, eclampsia, pre-eclampsia during pregnancy, traumatic brain injury, drug use.
To prevent the development of any complications of high blood pressure is very important regular intake of drugs. Moreover, combination therapy is typically of 2 or 3 drugs. When properly selected treatment and compliance with all the doctor's recommendations for the correction of lifestyle crises frequency is sharply reduced, especially complicated.
In complicated hypertensive crisis develops:
hypertensive encephalopathy
- harakterizuyuetsya headache, confusion, nausea and vomiting, convulsions, coma development.
Acute ischemic stroke:
- impaired hearing, vision, motor skills, sensitivity of the skin.
Acute heart failure
- dyspnea, crackles in the lungs, pink frothing at the mouth.
Acute coronary syndrome - a clinical syndrome comprising:
- expressed by the burning pain behind the sternum, extending to the left shoulder blade, the lower jaw, as well as the corresponding changes in the electrocardiogram.
Dissecting aortic aneurysm.
- With the defeat of the thoracic aorta - the most severe chest pain sometimes with the development of conditions of shock, the sharp decline in blood pressure, loss of consciousness.
- When the bundle of abdominal aortic aneurysm patients complain of severe pain in the abdomen of different localization, are not tested after receiving analgesic drugs, even drugs.
- Also bundle aneurysm characteristic features limb ischemia (their cooling, blanching, decreasing heart rate, decreased sensitivity) ischemia of the brain and spinal cord developmental disorders of sensitivity of the skin, limb motor function, incontinence or stool urine; cardiac tamponade (dyspnea, sudden chest pain, blue upper body, swelling of the jugular veins in the neck, loss of consciousness).
Forecast
Prognosis depends on the correct diagnosis. In the case of correct identification of the causes of high blood pressure therapy is chosen correctly and forecast in this case the most favorable.
In this case, the patient is important to understand that by its action also depends on the outcome of the disease. If he does not respect the doctor's advice, especially with regard to correction of lifestyle, the effectiveness of antihypertensive therapy significantly reduced.
Forecast greatly deteriorates of complications of hypertensive crisis. Approximately 3% of such patients develop kidney failure that requires dialysis. A 25-40% underwent crisis complicated die within 3 years from stroke or renal failure.
prevention
Hypertension - a chronic disease that requires constant monitoring of blood pressure and regular medication. Obligatory routine visits to the physician or cardiologist to evaluate the effectiveness of therapy.
Be sure to maintain a personal diary of blood pressure, which is noted for its daily morning, evening measurement, as well as unscheduled when a sharp rise in this case should also be noted symptoms.
Prevention hypertensive crisis also includes dieting with a reduced content of salts, fatty foods, excess liquid. Also of great importance is attached to smoking cessation, alcohol and weight normalization.
Medication must be regular. Drugs should not be changed too often, even within the same active ingredient.
Patients are advised to attend the schools of patients with hypertension who are held in hospitals of the city. The presence of such schools can be obtained from your doctor.
complications
When chronically high blood pressure, hypertensive retinopathy develops, which is expressed in the deterioration of the patients due to retinal vascular lesions.
Authorities, who are most affected by increasing the pressure, the kidney. It is the principal regulator of blood pressure in the body and damage their vessels occurs a vicious circle, which worsens hypertension.
Complications develop an appropriate embodiment of a hypertensive crisis. Among them, cerebral infarction frequency (or ischemic stroke), pulmonary edema, hypertension encephalopathy, acute heart failure, myocardial infarction or unstable angina, hemorrhagic stroke or subarachnoid hemorrhage, eclampsia in pregnant women, the bundle aorta.
In women after menopause hypertensive crises occur, usually worse than those of men. The reason lies in a more fragile vessels that are easier damaged by a sharp rise in blood pressure. Because of this stroke as a complication of hypertensive crisis, it is more likely to occur in women.
sources:
- 1.The standard of care for patients with diseases characterized by high blood pressure. - the Russian Federation Order of the Ministry of Health and Social Development on 4 September 2006 № 632
- 2. Russian Medical Society of Arterial Hypertension. Arterial hypertension in adults. - Federal clinical guidelines 2016.
