Hypertensive crisis is one of the conditions that is characterized by a sharp increase in blood pressure. It is characterized by damage to the target organ and the presence of all symptoms of hypertension, but expressed excessively. There are two mechanisms for increasing pressure (vascular and cardiac) that characterize the hypertensive crisis. The treatment of this condition largely depends on these mechanisms.
A developmental mechanism that describes a hypertensive crisis. Treatment, as you know, is often built on the basis of pathogenesis. In this condition, spasm of arterioles develops, heart rate and total peripheral vascular resistance increase. A vicious cycle of reactions develops with a persistent and sharp increase in blood pressure to a very high level.
Symptoms
• headache caused by a violation of the blood supply to the brain. It is dull or pulsating;
• dizziness, tinnitus, nausea and vomiting, as well as brain symptoms;
• visual impairment due to spasm of the retinal vessels, as well as swelling of the optic disc;
• palpitations, arrhythmias, shortness of breath.
In connection with the presence of certain symptoms, crises of the first and second types are distinguished:
- the first type is hyperkinetic, occurs more often in the early stages of arterial hypertension. It begins acutely and with numerous vegetative symptoms: patient agitation, trembling, flushing of the skin, increased sweating. Such a crisis lasts about 3-4 hours. In this case, mainly systolic pressure rises with a constant diastolic pressure, and heart rate increases. An increase in the level of adrenaline in the circulating blood describes this hypertensive crisis. Treatment has a number of its features;
- the second type is hypokinetic, occurs in the later stages of arterial hypertension. It develops gradually, proceeds hard. Inhibition, lethargy of patients, severity of heart and brain symptoms are characteristic. Both systolic and diastolic pressure increase , but the level of the latter is more pronounced. Heart rate may not change. In the blood there is an increase in the level of norepinephrine.
With the development of the disease, complications may occur:
- encephalopathy and cerebral edema, which are characterized by various brain symptoms (convulsions, nausea, vomiting, impaired consciousness) ,
- heart failure,
- An attack of angina pectoris or myocardial infarction.
Given the mechanisms and symptoms that describe a hypertensive crisis, treatment will be structured as follows:
- a decrease in the level of diastolic pressure to a value of 100 mm Hg. It should be lowered very carefully so that the blood circulation of the brain is not disturbed. The patient needs to ensure a horizontal position;
- intravenous administration of enalapril (an angiotensin-converting enzyme inhibitor), nifedipine (calcium channel blocker), clonidine (α-adrenergic agonist);
- during the first 2 hours should not reduce the pressure by more than 25% of the initial level. In the next 6 hours it is necessary to achieve the level of blood pressure 160/100.
- urgent Care. Calling an ambulance is the first thing to do. Then, waiting for the doctor to arrive, it is necessary to give the patient a half-sitting position to prevent an attack of suffocation. If the attacks were earlier and the patient takes antihypertensive drugs, then it is necessary to drink the dose of the medicine recommended by the doctor. If you managed to reduce the pressure by 40-60mm Hg, then you should not take the medicine anymore. No need to take new and unfamiliar drugs. You can also drink a sedative, such as Corvalol.
Hypertensive crisis: consequences
The prognosis for this condition is unfavorable. For a hypertensive crisis, relapses are characteristic. After the crisis, heart failure, cerebrovascular accident, and even cerebral edema can develop.