Hypertensive crisis is an urgent condition, which is caused by excessive high blood pressure, and which manifests itself with clinical picture of a specific lesion of the target organ.If there is an urgent need to reduce blood pressure for prevent organ damage outside.Such a pathological condition is one of the most frequent causes common to call emergency medical vehicles.In Western Europe in the last twenty years have seen a decrease in the frequency of occurrence of hypertensive crises in patients with hypertension.This is due to improved treatment of arterial hypertension and increase in the timely diagnosis of this disease.
Hypertensive crisis causes
cause of crises in hypertension is different.Hypertensive crises are taking place to develop the presence of arterial hypertension of any origin (hypertension disease and symptomatic hypertension in various kinds), and even with the rapid discontinuation of drugs that lower blood pressure (antihypertensives).This con
reasons that contribute to crises of hypertension:
|reasons exogenous||reasons endogenous|
| Stressed |
Excessive consumption of salt
abrupt withdrawal of the drug antihypertensive
cerebral ischemiawhich is due to a decrease in blood pressure as a result of receiving antihypertensive agents
Excessive consumption of alcoholic beverages
| Against the background of hormonal disorders in women during menopause. |
aggravation of ischemic heart disease (acute failure, asthma, cardiac, cerebrovascular accidents)
With prostate cancer, urodynamic disorders
Hypertensive crisis in pheochromocytoma is a result of increasing levels of catecholamines.It also occurs in acute glomerulonephritis.When Cohn
syndrome aldosterone hypersecretion occurs, which leads to increased excretion of potassium and promotes redistribution in the body of electrolyte, thereby leading to the accumulation of sodium and an increase in peripheral vascular resistance eventually.
Occasionally hypertensive crisis develops due to the mechanism of reflex reaction in response to a lack of oxygen (hypoxia) or brain ischemia (ganglioblokatorov application, the use of sympathomimetic also cancel antihypertensive drugs).
risk of hypertensive crises has in the acute damage of certain target organs.Disorders of regional circulation identified as acute hypertensive encephalopathy, acute coronary insufficiency, stroke and acute heart failure.Damage to target organs occurs as at the peak of a crisis, and due to a sharp decrease in blood pressure, especially in people aged older.
3 Identify mechanism of hypertensive crisis:
- increased blood pressure overreaction vasoconstrictive cerebral vessels;
- a violation of local blood circulation of brain;
- hypotonic crises.
hypertensive crisis symptoms
main symptom of crisis hypertensive is a sharp increase in pressure in blood, which manifests significant increase circulation of brain and kidney, because of which substantially increases the risk of serious complications of cardiovascular (myocardial infarction, stroke, hemorrhage, subarachnoid aneurysmdissecting aorta, acute renal failure, pulmonary edema, acute coronary insufficiency, etc.).
development of hypertensive crisis manifests itself: a nervous excitement, worry, anxiety, frequent palpitations, cold sweat, feeling short of breath, tremor of the hands, goose bumps, redness of the face.
Because of cerebrovascular accidents occur: nausea, dizziness, vomiting, blurred vision.
Symptoms of hypertensive crises are very diverse.Still, the most common symptom, which is observed in the early stages in the development of crises, it is a headache, which also may be accompanied by nausea, vomiting, vertigo, tinnitus.As a rule, this headache is enhanced by sneezing, head movement, defecation.Moreover, it is also accompanied by pain in the eyes when moving the eyes and photophobia.
In the event of a malignant change in the development of essential hypertension headache occurs due to a significant increase in blood pressure and intracranial pressure, cerebral edema and cerebral accompanied by nausea, blurred vision.
also another common manifestation of hypertensive crises seems dizzy - in this case it seems that the surrounding objects, as it were, "revolve".Dizziness are two types: 1) the dizziness that occurs and is enhanced by changing the position of the head, 2) dizziness, which occurs irrespective of the provisions of the head and is not accompanied by a sense of movement.
Help for hypertensive crisis
First aid for hypertensive Stroke:
Depending on the complexity of the patient need to call an ambulance.
plant a half-sitting position of the patient (eg, in the chair), to provide peace, put a small pillow under your head.
man who suffers from hypertension, should advance to talk with your doctor about what medicines they should take for relief of hypertensive crisis.As a rule, it can be Capoten (½-1 tablet under your tongue until complete resorption) or Corinfar (1 tablet under your tongue until complete resorption).
not be amiss to take a sedative (Valocordin, Corvalol).
necessary to fix the value of the level of blood pressure and pulse rate.Do not leave the patient unattended.The following medical recommendations will the doctor arrived the patient.
If you can not produce relief of hypertensive crisis or there are complications it, or it arose for the first time, that such a patient needs urgent hospitalization of Cardiology.
When relief of hypertensive crisis most often used:
- Clonidine (a drug to lower blood pressure) oral 0.2 mg, then 0.1 mg every hour until the pressure reduction;intravenous drip 1 mL of 0.01% in 10 ml of 0.9% sodium chloride.
- Nifedipine (a calcium channel blocker, expands coronary and peripheral vessels and relaxes the smooth muscles) at 5 at 10 mg in the Table.shaped chew, then put under the tongue or swallowed;with caution in hypertensive encephalopathy, heart failure with pulmonary edema, swelling of the optic nerve.
- Sodium nitroprusside (vasodilator) intravenous drip in a dosage of 0.25-10 mg / kg per minute after the dosage is increased by 0.5 mg / kg per minute every 5 minutes.It will also be relevant while developing hypertensive encephalopathy, renal failure, when dissecting aortic aneurysm.If there is no pronounced effect within 10 minutes after the maximum dose, the administration was stopped.
- Diazoxide (direct vasodilator) 50 mg-150 mg intravenous bolus for 10-30 seconds, or slow the introduction of 15 mg to 30 mg per minute for 20-30 minutes.You may experience side effects such as tachycardia, hypertension, nausea, angina, edema, vomiting.
- Captopril (ACE inhibitor) 25-50 mg administered lingual.
- Labetalol (beta-blocker), 20-80 mg IV bolus every 10-15 minutes or drip method 50-300 mg of 0.5-2 mg per minute.It recommended for encephalopathy, renal failure.
- Fentolamin (alpha blocker) 5-15 mg dose intravenously for hypertensive crisis which is associated with pheochromocytoma.
- enalapril (an ACE inhibitor) intravenous bolus over 5 minutes every 6 hours at a dose of 0,625-1,25 mg, which diluted with 50 ml of 5% glucose solution or physiological solution;Stroke in the hypertensive patients with acute ischemic heart disease, encephalopathy, chronic congestive heart failure.
hypertensive crisis when arresting the above drugs may be used in combination with each other or in combination with other antihypertensive agents, especially with ß-blockers and diuretics.
treatment for hypertensive crisis with complications of any delay in treatment can lead to irreversible consequences.The patient was hospitalized in the intensive care ward and immediately begin to intravenous administration of one of the drugs listed below.
Medications for / in the complicated hypertensive crises when
|name||Dosage and method of administration.||Home||duration||Notes|
|Medications that relax blood vessels|
|sodium nitroprusside||In / in, drip 0.25-10 mg / kg per minute (50-100 ml 250-500ml of 5% glucose)||Immediately||3 minutes||immediately lowers blood pressure in hypertensive crises.Enter under the control of blood pressure.|
|Nitroglycerin||In / in, drip, 50-200 micrograms per minute||5 minutes||10 minutes||Effective myocardial infarction, congestive heart failure.|
|Nicardipine||In / in, drip, 5-15 mg per hour||10 minutes||12 hours at||prolonged administration is contraindicated in patients with heart failure.|
|verapamil||V / 5-10 mg||5 minutes||One hour||contraindicated in patients with heart failure|
|Hydralazine||In / in the jet, 10-20 mg per 20 ml of solutionisotonic||20 minutes||6:00||can repeat administration after 3-6 hours.|
|enalaprilate||In / in, 1,25-5 mg||30 minutes||12:00||Effective with left ventricular heart failure|
|Nimodipine||In / in, drip, 15 mg / kg||hour 20 minutes||4:00||subarachnoid hemorrhage|
|Fenoldopam||In / in, drip, 0.1-0.3 mg / kg per minute for 5 minutes||30 minutes||Effective in many hypertensive crises|
|Labetalol||In / in the jet, 20-80 mg at 2 mg per minute||10 minutes||5:00||Contraindications: heart failure.|
|Propranolol||BH / in, drip 5 mg at a rate of 0.1 mg per minute for 20 minutes||3:00||mainly at coronary syndrome and dissecting aortic aneurysm|
|Esmolol||In /in, drip 250-500 mcg / kg per minute for a minute||1 minute||10 minutes||is the main drug in postoperative hypertensive crisis and dissecting aortic aneurysm|
|trimetafan camsylate||In / in, drip, 1-4 mg / min||Instantly||3 minutes||In PNDS crises with swelling of the brain, lungs or dissecting aortic aneurysm|
|clonidine (clonidine)||B / 0.5-1.0 ml, or intramuscularly0.5 ml of 0.01% solution||5 minutes||5:00||wary stroke|
|Azametony bromide||In / in, 0,2-0,75 ml or intramuscularly 1 ml of 5% solution||15 minutes||3:00||orthostatic hypotension Causes.|
|Fentolamin||Intravenous||One minute||10 minutes||especially in pheochromocytoma.|
Hypertensive crisis emergency care
for hypertensive crisis emergency care is provided for the purpose, seeking as quickly as possible to lower blood pressure in humans, or irreversible organ damage internal inevitable.
Therefore the use of these drugs it is advisable to always have on hand in case of need relief of hypertensive crisis if urgent condition or Corinfar or hood, while the upper (systolic pressure of blood more than 200 mm Hg. Or Clonidine sublingually. The effect comes after half an hour. Whenblood pressure decreased by twenty-five percent, he was more rapidly reduce unnecessary. Bringing the above measures will be enough. But if the use of these drugs the patient's condition does not improve or gets worse, on the contrary, should immediately seek medical ambulance. Early medical advice treatment and the callemergency medical assistance in hypertensive Stroke will ensure effective treatment and to avoid irreparable consequences.
By calling 03 to cause a brigade of medical emergency, it is necessary to formulate a (clear) dispatcher patient symptoms and indicators of his blood pressure.Basically, hospitalization may be avoided, with the proviso that hypertensive crisis patient no complicated internal organs damages.But it is also necessary to be prepared for the fact that hospitalization may be required if a hypertensive crisis first arose.
Before the arrival of the ambulance must be:
patient with an attack of a hypertensive crisis should be in bed to put a few extra pillows, thereby giving him a semi-sitting position of the body.This is a very important measure is necessary for the prevention of choking or shortness of breath, and it can often occur when hypertensive Stroke.
If the person is already in the outpatient treatment of hypertension, he must be sure to take a dose of (extraordinary) of their antihypertensive medication.The drug will work best effective if given sublingual way, so to speak, dispersal under the tongue.
should strive to lower blood pressure figures by 30 mm.of mercury for half an hour and 50 mm.Hg for one hour from the original blood pressure.When managed to achieve a good reduction, then take additional methods of lowering the blood pressure should not be.Danger also very sharply "churn" blood pressure to normal levels, because it can lead to disorders of cerebral circulation, sometimes irreversible.
can also take sedative drugs, for example valokardin to achieve the normalization of the excited state of the patient's psycho-emotional, help him get rid of the fear, panic and anxiety.
person with hypertensive crisis before the arrival of the doctor should not take vserazlichnye drugs without urgent need.This is very unnecessary risk.It would be correct to wait for the arrival of teams of emergency ambulance, which will select the most appropriate drug and will be able to enter it by injection.The same team of doctors, if necessary, may decide on hospitalization of the patient to the hospital or take a decision on his treatment on an outpatient basis, ie at home.After the relief of hypertensive crisis is made, it is necessary to consult a doctor-cardiologist or physician, so that he could pick the best tool for the adequate hypotensive therapy of hypertension.
After hypertensive crisis
consequences of hypertensive crisis can be really scary.It may be irreversible changes in the internal organs and systems that further mandatory impact on the quality of life of the patient.For the purposes of normal life in the future after a bout of hypertensive crisis prevention must be observed.