Hypertensive crisis - one of the conditions that is characterized bya sharp increase in blood pressure. It is characterized by the defeat of the target organ and the presence of all the symptoms of hypertension, but expressed excessively. There are two mechanisms of increasing pressure (vascular and cardiac), which characterize the hypertensive crisis. Treatment of this condition largely depends on these mechanisms.
The mechanism of development, which describes the hypertensive crisis. Treatment, as is known, is often built,relying on the pathogenesis. With this condition, spasm of arterioles develops, heart rate rises and the overall peripheral resistance of blood vessels. A vicious circle of reactions develops with a persistent and sharp increase in blood pressure to a very high level.
• headache caused by impaired blood flow to the brain. Worn by a dull or pulsating character;
• dizziness, tinnitus, nausea and vomiting, as well as brain symptoms;
• Impairment of vision due to spasm of retinal vessels, as well as edema of the optic disc;
• palpitations, arrhythmias, dyspnea.
In connection with the presence of certain symptoms distinguish crises of the first and second kinds:
- The first kind - hyperkinetic, arises more often onearly terms of hypertension. It begins acutely and with numerous vegetative symptoms: excitation of the patient, trembling, hyperemia of the skin, increased sweating. This crisis lasts about 3-4 hours. In this case, the systolic pressure increases with a constant diastolic pressure, the heart rate rises. Increasing the level of adrenaline in the circulating blood describes this hypertensive crisis. Treatment has a number of features;
- the second type - hypokinetic, occurs onlate terms of hypertension. It develops gradually, it is difficult. Typical inhibition, lethargic patients, the severity of heart and brain symptoms. Both systolic and diastolic pressure increase, but the level of the latter is more pronounced. The heart rate may not change. In the blood there is an increase in the level of norepinephrine.
When the disease develops, complications can occur:
- encephalopathy and cerebral edema, which are characterized by various brain symptoms (convulsions, nausea, vomiting, impaired consciousness),
- heart failure,
- an attack of angina or myocardial infarction.
Given the mechanisms and symptoms that describe the hypertensive crisis, the treatment will be structured as follows:
- decrease of diastolic pressure level up tovalues of 100 mm Hg. Lower it should be very carefully so that the blood circulation of the brain is not disturbed. The patient should be provided with a horizontal position;
- intravenous enalapril (angiotensin-converting enzyme inhibitor), nifedipine (calcium channel blocker), clonidine (α-adrenomimetic);
- During the first 2 hours, do not reduce the pressure by more than 25% of the initial level. In the next 6 hours, it is necessary to reach the blood pressure level of 160/100.
- urgent care. Calling the ambulance is the first thing to do. Then, waiting for the doctor to arrive, it is necessary to give the patient a semi-sitting position to prevent an attack of suffocation. If the seizures were earlier and the patient takes antihypertensive medications, then it is necessary to drink the recommended dose of the medicine. If it was possible to reduce the pressure by 40-60 mm Hg, then no more use of the medicine. Do not also take new and unfamiliar drugs. You can also drink a sedative, for example, Corvalol.
Hypertensive crisis: consequences
Forecast for this conditionadverse. For a hypertensive crisis, relapses are characteristic. After a crisis, heart failure, cerebral circulatory disorders, up to cerebral edema can develop.