Hypertensive Crisis - Very High Blood Pressure

Hypertension is a chronic and silent disease that causes lesions in various organs of the body slowly and progressively. In general, it takes several years of poorly controlled blood pressure until the patient begins to show irreversible damage, such as damage to the heart, kidneys, brain and eyes.

Very high blood pressure
Very high blood pressure

However, hypertensive patients can present hypertensive crises, which are episodes of abrupt rise in blood pressure, far above the usual values. Hypertensive crisis, if not controlled, can cause irreversible damage to the body relatively quickly.

Hypertensive crises are usually divided into two types:
  • Hypertensive urgency.
  • Hypertensive emergency.

In this article we will explain what a hypertensive crisis, what are its symptoms and how patients with sudden high blood pressure should be treated.

What is a hypertensive crisis?

Hypertensive crisis is an event characterized by elevated blood pressure to values, if not controlled, can cause severe damage to the blood vessels in a short time.

In general, considered hypertensive crisis when systolic blood pressure (highest high value, called maximum blood pressure) is above 180 mmHg or when diastolic pressure (higher value down, called minimal blood pressure) is above 110 mmHg. Therefore, a patient with blood pressure of 190/90 mmHg or 175/115 presents hypertensive crisis. The higher the value of the blood pressure, the more severe the crisis. Some patients even have 240 or 250 mmHg maximum pressure for a pressure peak.

Generally, hypertensive crisis occurring in patients who are not adequately treated for hypertension. The reasons usually are three:
  • Patient does not know who is hypertensive and therefore never took drugs.
  • The patient knows who is hypertensive, know you have to take medication for pressure, but do not take them correctly, either by choice or because the doctor did not explain the recipe clearly.
  • The patient knows who is hypertensive, properly take the drugs, but the doses or types of prescription drugs are not suited to that particular patient.

In some cases, the patient spends years with its more or less well controlled blood pressure, but a sudden, begins to exhibit hypertensive peaks. Situations that can cause uncontrolled blood pressure are:
  • Dietary changes, especially increasing salt consumption.
  • Relevant recent weight gain.
  • Exchange of drugs that was used to take.
  • Onset or worsening of diseases of the kidneys.

Even those patients who are always very high blood pressure, often above 180 mm Hg systolic pressure (maximum pressure), are characterized as having hypertensive crisis every time they have a peak pressure. Contrary to what some people think, the body does not get used to a very high pressure. As we shall see, the fact that no symptoms does not mean that hypertensive peaks do not do harm to their bodies.

Hypertensive urgency X Hypertensive emergency

As mentioned above, patients with hypertensive crisis are divided into two groups:

1. Hypertensive urgency

Hypertensive urgency is the most common form of hypertensive crisis.

Have hypertensive emergency patients with hypertensive peak, maximum pressure above 180 mmHg or minimum above 110 mmHg, but without relevant symptoms or signs of acute injury of some target organ (target organ is the name given to the organs usually damaged by high blood pressure, such as eyes, heart, brain and kidneys). By definition, hypertensive urgency is a type of hypertensive crisis that brings no risk of death or severe immediate damage.

It is important to note that although there is no immediate risk of death or serious injury of organs, hypertensive peaks accelerate the lesions in the body. While a patient with hypertension around 140 or 150 mmHg maximum pressure takes years, sometimes decades, to show some heart or kidney disease, patients with frequent episodes of hypertensive crisis may develop clinically apparent lesions in 2 or 3 years, the times less, if it has other risk factors such as diabetes or smoking.

Patients with hypertensive urgency usually do not have symptoms, the most headache, fatigue or a feeling of heaviness in the neck. Hypertensive patients who barely control their pressure and constantly have very high values are those that tolerate better hypertensive peaks without reporting complaints.

Hypertensive crisis should always be evaluated by a doctor because blood pressure needs to be controlled, initially to below 160/100 mmHg, and in the medium term to below 140/90 mmHg.

Since there is no imminent risk of death, blood pressure in hypertensive urgency can be reduced gradually over several hours or days. In elderly patients, the reduction has to be careful because sudden drops in blood pressure can trigger frames of myocardial infarction or stroke.

In general, patients with hypertensive urgencies need not be hospitalized and can control the pressure only oral medication. The important thing is to understand that the blood pressure of the patient is poorly controlled and it needs a closer medical supervision, for the medium term do not have more hypertensive peaks.

2. Hypertensive Emergency

Hypertensive emergency is distinguished from hypertensive urgency by the existence of acute injury of some target organ triggered by hypertensive peak. The value of the blood pressure itself is not used to differentiate the two forms of hypertensive crisis, for a patient with 220/100 mmHg may be asymptomatic, while another with 190/90 mmHg may be suffering a heart attack, which is an emergency.

The main complications that indicate the existence of a hypertensive emergency are:

Many emergency listed above may be triggered by a pressure peak, but they can also be the cause of pressure rise. For example, a patient may have a heart attack or having a stroke and, from this moment, set to have a high blood pressure, either by pain, difficulty breathing or even anxiety. In some situations it is difficult to establish which came first, as both act synergistically: high blood pressure aggravates infarction, which in turn encourages further agramento of hypertensive peak. In the end, no matter. Regardless of the source of the problem, the patient has a hypertensive emergency that must be treated.

The main symptoms of a hypertensive emergency are:
  • Chest pain
  • Severe shortness of breath
  • Mental status changes
  • Convulsive crisis
  • Visual disturbances such as blurred vision

Hypertensive emergency was formerly called malignant hypertension because, as there was no proper treatment, their short-term mortality was very high. Before the 1950s, more than 80% of patients with hypertensive emergency died within 1 year. Currently, malignant hypertension term has fallen into disuse. However, some authors still use this term to describe a form of hypertensive emergency that specifically affects eye and kidney acutely.

With modern treatment, the acute mortality rate of hypertensive emergency fell considerably. Nowadays, after a year of crisis, more than 90% of the patients is still being alive.

hypertensive emergency patients should be hospitalized and treated immediately. The goal in these cases is to control the blood pressure quickly, in a matter of hours. The only exception is the case of stroke, since the abrupt reduction in blood pressure may aggravate cerebral ischemia.

In most cases, patients with hypertensive emergency need drugs intravenously for better control of blood pressure.

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