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The symptoms, consequences and first aid in hypertensive crisis

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What is hypertensive crisis?

Hypertensive crisis is a sudden increase in blood pressure, resulting in rapidly deteriorating health of the person. To predict the development of a crisis is very difficult. For each patient in hypertensive crisis is characterized by elevated levels of blood pressure, which differs from regular. Even if the measured pressure for most people is considered normal for that person it may be too high.

What is the danger of hypertensive crisis?

Hypertensive crisis is dangerous because it causes serious complication – it affects the vital organs: liver, kidneys, heart and brain. In addition, a hypertensive crisis can lead to vision loss. So when you see symptoms of a crisis it is important to promptly and efficiently provide assistance. It is how to eliminate the symptoms and prevent complications. Drugs, allowing to quickly restore normal blood pressure, should be adjusted by a qualified technician. Overdose of drugs or too strong action could cause additional problems with blood supply. In this case, tissues and organs are deprived of necessary oxygen.

The doctor selects the drug, taking into account the age of the patient and characteristics of his body. Assistance with hypertensive crisis it is important to accurately calculate the speed of decrease in blood pressure and the optimal level that should be achieved.

Risk factors

The causes of this condition in humans are:

  • stress or emotional tension;

  • changing weather conditions: cold, warming, winds;
  • alcohol poisoning;
  • the use of large amounts of salt;
  • cancellation of therapy in those who have long took antihypertensive drugs.

However, the most common cause still remains nervous overstrain. Among the main manifestations of hypertensive crisis – a sense of fear and anxiety, which mustto get rid of in the first place, so that the pressure returned to normal.

Types of hypertensive crisis

The crisis is of two types, depending on severity:

  • Hypertonic crisis of the first type is easier and faster. The attack can last only a few hours. At this time the patient is agitated, suffers from headache, dizziness, feels discomfort in the heart area. Possible body shiver. External characteristics the most striking is the redness of the face and neck. When the biochemical analysis of blood during a hypertensive crisis of the first type revealed elevated white blood cell count and urinary protein. Pressure rises, pulse quickens. This type of hypertensive crisis is often called uncomplicated. This means that during exacerbation of the disease do not suffer the target organs (brain, heart, kidneys). To cope with the crisis, it is necessary to provide patient assistance during the day. Most often, it is enough to use of medicines and compliance with bed rest. In uncomplicated hypertensive crisis, no need for hospitalization;

  • A hypertensive crisis of the second type lasts for several days. The symptoms in this case are the same, however, they are expressed stronger. The patient experiences dizziness, cardiac pain, nausea turning into vomiting, blurred vision. Among the main complications – heart attack, stroke, pulmonary edema. The blood tests showed increased erythrocyte sedimentation rate and elevated white cell count. This type of crisis is known as complicated. In most cases the patient have to be hospitalized, as there is a threat of defeat of target organs. Assistance should be provided immediately, otherwise you will not be able to avoid serious complications or death.

Complicated hypertensive crisis usually recurs in the form of recurrent seizures. At risk patients suffering from chronic arterial hypertension. To avoid crises, you need to follow the course of the disease. Among patients with hypertension is marked by high mortality due to hypertensive crises.

Epidemiology

In most cases, challenge teams of emergency medical care is due to a hypertensive crisis. Depending on the region, patients receive treatment in different quality, also varies the degree of complications. The most favorable situation in Western Europe. There is a number of caseshypertensive crisis decreased due to the high level of development of medicine. It is also connected with high-quality diagnosis, allowing time to identify the presence of the disease and prevent it worsening.

Russia is significantly lagging behind in this indicator. Only a quarter of patients receive timely treatment, so the cases of hypertensive crisis occur more often. They are more prevalent among women. Men suffer from hypertensive crisis less likely. The frequency of exacerbations of the disease is largely due to the imperfect system of medical institutions in Russia and the lack of coordinated work of emergency teams, outpatient clinics and inpatient wards.


Symptoms of hypertensive crisis

Symptoms of hypertensive crisis are:

  • A sharp increase in blood pressure. It is considered that hypertensive crisis when the systolic pressure exceeds 150 mm Hg figure. St. However, the upper limit value of AD depends largely on the individual, so you should consider what level of pressure is normal for each individual patient. For some, even "upper" pressure 130 mm Hg. the article can be critical;
  • Headache that is localized in the neck, and dizziness;
  • Nausea turning into vomiting – this symptom is more common for complicated hypertensive crisis;
  • Vision problems – some patients complain of the appearance of spots before the eyes, possible partial blindness;
  • Nystagmus is involuntary oscillation of the eyeball. Depending on the direction, nystagmus can be vertical, horizontal, rotational or a pendulum;

  • The increase in body temperature;

  • Redness of the skin on the face and neck;
  • Trembling throughout the body;
  • The feeling of fear and panic is a common symptoms of hypertensive crisis as it is often caused by emotional tension or stress.

First of all, should be restored to normal psychological condition of the patient for the recovery to deal with fear and panic, causing the following symptoms:

  • palpitations and arrhythmias, shortness of breath;
  • sweating;
  • violation of coordination of movements, unsteadinessgait.

In accordance with the classification and depending on the symptoms and causes, there are several types of hypertensive crisis:

  • The first type is associated with neurovegetative syndrome. The cause of the crisis in this case becomes psychological stress, severe stress. The main symptoms are dizziness, nausea, vomiting, headache. All manifestations of this type of hypertensive crisis held a few hours later. Hospitalization of the patient is not required because there is no threat to his life;
  • The second type of hypertensive crisis – water-salt. The renin-angiotensin-aldosterone system in the human body maintains a constant internal environment. When its work is disrupted, what happens water-salt hypertensive crisis. Patients experience nausea, headaches, losing orientation in space, they have impaired vision, including, observed nystagmus. The worsening of the disease in this form lasts for several days and then passes;

  • The most difficult type of crisis is an acute hypertensive encephalopathy. This requires hospitalization of the patient, as a result of a significant increase in blood pressure disturbed cerebral blood flow and develop serious complications, such as seizures, dizziness, heart attack or stroke.

On topic: Hypertension 1, 2, 3 and 4 degrees


The consequences of a hypertensive crisis

The lack of timely medical care at hypertensive crisis can lead to serious consequences – kidney damage, blood vessels, heart, brain, pulmonary edema, myocardial infarction, angina. Often develop disorders of the Central nervous system, e.g. brain stem stroke or coma.

Dizziness

After hypertension, many patients experience difficulty with orientation in space and the sensation of their body in it, feel very dizzy. You must contact your doctor to determine the exact cause of this phenomenon.

Perhaps the dizziness brought not a hypertensive crisis, and other disease. During the attack which usually catches off guard, you need not to panic, to sit down and close my eyes and try to focus on anything.

If you have a headache...

Headaches – the most common symptom ofhypertensive crisis, and one of its possible consequences. The bout is over, but the discomfort in the neck remain. This requires medication, which may appoint only physician.

Many drugs that are used in hypertensive crisis are potent, so dosage must be precisely calculated. During the rehabilitation period after the attack, it is recommended to stay in bed that will ease the consequences in the form of a headache. However, to endure it is not necessary, it is necessary to consult a specialist who will recommend the anesthetic.

On topic: As for 3 minutes to reduce the pressure 20-30 points?


The algorithm of actions in hypertensive crisis

Before to start treatment of hypertensive crisis and to use potent drugs, should help the patient to cope with fear and anxiety which inevitably arise in such cases.

To get rid of psychological discomfort allows the tincture of Valerian, Corvalol, motherwort. The breathing should be smooth. To restore it will help a few deep breaths. It is also important to provide fresh air into the room and lay the patient on the bed or sit on the chair.

Reduce the pressure until arrival of the ambulance using the drug prescribed by the attending physician. If the patient experiences severe pain in the chest, used nitroglycerin. Every quarter of an hour to measure pressure. If within a couple of hours don't start to improve, you need to call the doctor.

To provide skilled care doctor should receive the fullest information on the nature of the patient's disease and find out the following:

  • how long has he developed hypertension;
  • what pressure for the patient is considered high and some low;
  • how long is the attack;
  • if the patient takes any medications regularly;
  • what drugs are used since the beginning of this hypertensive crisis;

  • if the patient suffers from chronic diseases such as diabetes.

The more the doctor will know about the features of the patient, the faster he will be able to assist. In addition, the specialist must determine the type of hypertensive crisis, depending on what is prescribed treatment.

The first type is hyperkinetic hypertensive crisis associated with the increasing intensity of the heart in the background andthere is an increase in systolic blood pressure, at the same time, these processes did not affect diastolic blood pressure. The patient has profuse sweating, tachycardia. A few hours later hypertensive crisis passes.

The second type of crisis – hypokinetic. It is manifested in the change in diastolic and systolic blood pressure. Hypertensive crisis occurs in a few days, the patient feels General weakness, a noticeable reddening of the skin, on it there are stains. Often the affected target organs. To choose drugs for a patient's care, the emergency physician must determine the type of hypertensive crisis in accordance with this classification. Medicines are administered intravenously or taken orally depending on, complicated or not complicated hypertensive crisis.

Relief of uncomplicated hypertensive crisis suggests a gradual decrease in blood pressure. In the case of hyperkinetic crisis sufficient use of a single drug, with hypokinetic therapy must be comprehensive.

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Drugs for intravenous injection in treatment of complicated hypertensive crisis

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Medications for the treatment of uncomplicated hypertension

For the treatment of uncomplicated hypertension are predominantly used drugs that is taken orally: clonidine, nifedipine or captopril.

Clonidine (clonidine)

The main advantage of this drug is that it can be used to treat patients with tachycardia. A number of drugs used for relief of hypertensive crisis, is able to increase cardiac output. Clonidine has no such properties. Faster it just allows you to reduce the pressure when administered intramuscularly. Oral achieve the desired effect in an hour. If after the first application of pressure is not reduced, the procedure is repeated again after 60 minutes.

Receiving clonidine is contraindicated in difficultthe work and the need for constant concentration. This is due to the strong sedative effect that the drug has on the body. Sedative effect of clonidine may be excessive, making it difficult to adequately assess the patient's condition. Therefore, if the cause of hypertensive crisis was a mental disorder, you need to use a different tool. The drug should also not be combined with alcohol.

Nifedipine

This drug is rapidly relaxes blood vessels and facilitates blood flow. Nifedipine is available in tablets, which are first chewed and then swallowed. The maximum period of time that allows you to achieve the desired effect half an hour. Typically, the pressure decreases more rapidly. To maintain the achieved result could in a few hours.

According to American scientists, the regular use of nifedipine may lead to a negative result and contribute to the development of ischemia. This is due to too a high rate of lower blood pressure under the action of the drug. Since some patients after taking nifedipine feel severe headaches, the use of this agent in hypertensive crisis is possible only for those who have already been treated and they are not faced with the side effects.

Captopril

This inexpensive but effective product that allows you to quickly lower blood pressure during hypertensive crisis. Among its main advantages noted safety for elderly patients. In addition, after his admission, there is no deterioration of cerebral blood flow. Captopril is recommended only in cases of emergency in hypertensive crisis, but also to normalize blood pressure.

Complicated hypertensive crisis requires the use of drugs that are administered intravenously. This allows you to quickly reduce the pressure to the desired level.


Medications for emergency treatment - overview

Sodium nitroprusside

This drug quickly reduces blood pressure, though its effect can be controlled. To achieve the desired effect after only a few minutes after the injection of sodium nitroprusside. During administration of the drug should continuously monitor blood pressure.

The use of sodium nitroprusside causes vasodilatation and slowing of the heartbeat. All of this leads to redistribution of the blood flow, and ischemic heart disease – worsening of coronary blood flow. The drug stays in the blood for a long time, so when taking it in large doses, possible toxic poisoning. It takes the formthe nausea and weakness.

Nitroglycerin

Nitroglycerin is often used in the form of tablets, however, a more effective injection. It has a rapid effect on the body, which also quickly terminated. To adjust the rate of decline in blood pressure can gradually increasing the dosage.

Nitroglycerin is reminiscent of sodium nitroprusside, but it has a significant advantage, as it does not increases the blood supply to individual areas of the cardiac muscle in patients with ischemic heart disease.

The diazoxide

Today this drug compared with other drugs from the same group is rare. This is due to various side effects that it causes. Pressure reduction with diazoxide is accompanied by reddening of the skin, dizziness and severe headaches.

To minimize side effects, the drug should be administered in combination with other medications, or resorting to drip method. In most cases, injections are performed in small doses through the small gaps of time.

Hydralazine

Intravenous or intramuscular injection gidralazina helps to relax the arteries and lower blood pressure. Thus tachycardia occurs. Also, in most cases, the use of this drug cause a headache, as it increases intracranial pressure.

Hydralazine is not suitable for patients with ischemic heart disease and aortic aneurysm. But it is an effective remedy for hypertensive crisis in pregnant women suffering from eclampsia, as it is absolutely safe for health of both mother and child.

Trimetafan camsylate

Injection of this drug is carried out intramuscularly. Its action is of short duration, and rate of blood pressure reduction can be easily controlled. Trimetafan camsylate reduces the force of heart contractions, therefore suitable for patients with aortic aneurysm. Today it is often replaced by more modern drugs, but still used in some cases.

After several months of regular intake trimetafan camsylate is addictive, thereby reducing the effect of them on the body. In this case, the drug has to be replaced because it does not allow you to lower your blood pressure to the desired level.

Azametonia bromide

Acute left ventricular failure requires a special approach in the relief of hypertensive crisis. In this case, the aid comes azametonia bromide. He is introducedintravenously and is valid for a long time – the effect lasts up to 7 hours.

Most often, doctors tend to use other drugs, so as to precisely dose azametonia bromide difficult. Overdose pressure may drop to critical values.

Phentolamine

If the cause of hypertensive crisis is getting a significant amount of catecholamines, it is advisable to apply phentolamine. Lower the pressure with phentolamine can be a maximum of a quarter of an hour. Among the side effects of the drug dizziness, tachycardia, headaches.

Labetalol

Labetalol is an effective drug that has almost no contraindications. It is not recommended to resort to his help only in cases when the patient has acute failure of the left ventricle of the heart. The effect of the drug begins minutes after intravenous injection. The effect may persist for up to 6 hours.

Esmolol

This drug is non-toxic due to rapid breakdown in the blood. However, for the same reason, it stopped after half an hour after injection. Therefore, the use of esmolol is reasonable only for patients with aortic aneurysm.

Enalaprilat

Lowering blood pressure with enalaprilat not accompanied by a reduction of blood supply to the brain, so the drug is suitable for patients suffering from heart failure. Its effect is enhanced when combined with certain antihypertensives.

The nicardipine and other calcium antagonists

Among the calcium antagonists are the most popular nicardipine, nimodipine and verapamil. The nicardipine has good portability, but in some cases there may be sweating, headaches and nausea. It is not recommended in severe heart failure.

Nimodipine from all the other calcium antagonists is characterized in that it has a strong impact on blood flow to the brain. Verapamil can be used in emergency situations to relieve the pressure and prevent arrhythmias and angina.

Fenoldopam

The action of fenoldopam is reminiscent of the effect of sodium nitroprusside. However, there is much less risk of side effects. This drug is recommended to appoint patients with renal failure because fenoldopam increases the excretion of fluids from the body.

Diuretics for edema hypertensive crises

Drugs from group of diureticsused in cases when the patient during a hypertensive crisis occurs fluid retention in the body. If the volume of circulated blood is non-standard, then the use of such drugs is contraindicated. They can cause severe vomiting or impaired urination.

Magnesium sulfate

Magnesium sulfate is known for its antispasmodic, anticonvulsant and dehydrating effect. It intramuscular or intravenous injection causes inhibition of vasomotor center, causing the pressure decreases.