Uncomplicated hypertensive crisis. Features of the course of uncomplicated hypertensive crisis Uncomplicated hypertensive crisis emergency care

An uncomplicated hypertensive crisis manifests itself as an increase in blood pressure (blood pressure), against which a number of symptoms arise. There is no damage to target organs with this form of pathology, therefore it is less dangerous, but it is still necessary to achieve a decrease in pressure gradually so as not to incur the risk of ischemia. So, uncomplicated hypertensive crisis, its symptoms, causes and treatment.

Features of the disease

The peculiarity of a crisis is that its onset is strictly individual and depends only on the capabilities of the body.

So, some people experience it even when their blood pressure increases to 140/90 mm. rt. Art. Therefore, the lower pressure values ​​at the time of an attack are very individual. As for the upper ones, numbers from 240/140 mm are considered critical. rt. Art.

People over 40 years of age are considered to be at risk, while children and adolescents are less susceptible to the disease.

Classification

1. At the end of the last century, a special classification of the disease was carried out, which makes it possible to quickly select the appropriate treatment. According to data, uncomplicated hypertensive crises are:
2. catecholamines,
3. renin dependent,

sodium dependent.

It is impossible to accurately predict the pattern according to which the increase in blood pressure will occur. The creator of the system, Lareg, in this case recommends monitoring the patient, prescribing each of the drugs in turn.

Forms

• Based on the signs observed in the diagnosis of an uncomplicated crisis, the disease is differentiated into hypokinetic and hyperkinetic forms.
• The first type of pathology is characterized by a number of symptoms such as pallor, a serious increase in diastolic pressure, the attack develops slowly, and signs from target organs often appear.

A hyperkinetic attack can be stopped with a single drug, while a hypokinetic attack will require complex therapy. The pathology of this form is characterized by rapid development, hyperemia (pathological redness of the skin), a strong increase in systolic pressure, and anxiety.

Read below about the symptoms and causes of uncomplicated hypertensive crisis.

Causes

• The causes of uncomplicated hypertensive crisis include:
• stress,
• fatigue,
• drinking coffee,
• thyroid diseases,
• vascular diseases,
• polyarthritis,
• diabetes,
• physical overload,

A crisis can occur due to the refusal of antihypertensive drugs or a change in atmospheric pressure. It often develops with diseases that provoke an increase in blood pressure (for example,), as well as with a lack of adequate antihypertensive therapy.

Symptoms

A distinctive symptom of a crisis is a headache of a pressing nature, and it can surround the head or be localized in any area.

It is often accompanied by nausea, loss of clarity of vision, tinnitus, dizziness, and vomiting.

Some people feel chest pain, so they confuse it with a manifestation of angina pectoris. High blood pressure is maintained for a long time, which is greatly facilitated by panic states.

The video below explains the symptoms of a hypertensive crisis in more detail:

Diagnostics

When diagnosing a crisis, special attention is paid to the anamnesis. After the examination, the patient must answer a number of questions that are important when prescribing treatment and on the basis of which all therapy is based. It is especially important to highlight all concomitant diseases, obtain information about past pathologies and even chronic ones.

The doctor must find out whether arterial hypertension has occurred before and what its duration was, what blood pressure numbers are considered normal for a person, and whether medication therapy has been previously administered. The duration of the attack, accompanying symptoms, as well as whether any medications were taken before contacting a specialist are also determined.

If there are symptoms of the cardiovascular system, then special attention should also be paid to the study of the ECG. It is necessary to exclude the possibility and development of coronary syndrome. In the examination, the possibility of its development is indicated by a depressed ST segment, as well as a negative and symmetrical T tooth.

We will discuss below what treatment tactics are used for uncomplicated hypertensive crisis.

Treatment

Therapeutic

After an attack occurs, all recommendations given by the doctor are strictly followed. The main treatment consists of competent drug therapy, but we must not forget that one’s own participation and awareness play a significant role in achieving a positive effect from treatment. In particular, you will need to eliminate bad habits from your life and, after stabilizing your blood pressure, accustom yourself to performing exercise therapy exercises.

Read on to find out what medications are used to treat hypertensive crisis.

Medication

The main goal of therapy is to gradually reduce pressure by no more than 25% of the existing one. Reducing it too quickly can lead to worsening symptoms and poor blood supply to organs. The doctor must select medications to stop the attack, since it is important to know not only the type of hypertensive crisis, but also the exact dosages of the medications, the method of administration to lower blood pressure strictly to certain values, and so on.

For both hypokinetic and hyperkinetic forms of the disease, treatment begins with the use of short-acting calcium antagonists. Such drugs include korenfar and nifedipine. In a small dosage (up to 30 mg), its absorption occurs quickly, which allows you to reduce blood pressure in the next 10-30 minutes. A calcium antagonist promotes relaxation of the vascular wall. However, their use is prohibited in cases of circulatory decompensation, tachycardia, and severe forms.

ACE inhibitors are no less effective, although they do not have any advantages over previous medications. For example, it begins to act in the same way after 10 minutes. During lactation and in case of renal failure, the use of the product is prohibited.

In many cases, these medications are sufficient to relieve an attack, but if the effectiveness is insufficient, then additional therapy is carried out:

• Stimulation of beta-adrenergic receptors. The administration of drugs in this spectrum is always accompanied by monitoring the heart rate and blood pressure levels. If it is impossible to use, use Proxodolol, which also helps to relax the vascular wall. The drug can be administered several times (no more than 10 ml for the entire time!) If there is no effect, every 10 minutes. Both medications should not be prescribed for worsened symptoms.
• If the patient experiences a pronounced feeling of fear, up to 4 ml of Droperidol is administered. The medicine has hypotensive and neuroleptic effects.
• If concomitant pathologies are identified in a patient, such as, for example, renal or circulatory failure, the best effect of treatment can be achieved by administering Furosemide.
• If signs of a crisis in the brain predominate for the most part, then more thorough antihypertensive therapy is carried out in combination with calcium antagonists. Injections or . give good results.

When the cause of an uncomplicated hypertensive crisis is the withdrawal of a habitual antihypertensive drug (for example, Clonidine), a small dosage of just such a medication is first administered.

It is necessarily called in the first case of a hypertensive crisis, if the medications taken do not have the desired effect, as well as in case of any cardiac symptoms. The algorithm for providing first aid for a hypertensive crisis, as well as the standards of emergency care and treatment in the clinic, is described in more detail in a special material.

We will tell you further about the treatment of uncomplicated hypertensive crisis with folk remedies.

Folk remedies

It is not recommended to use any medications on your own during a primary attack, so you can use some alternative treatment methods:

1. Prepare a warm bath, add some mustard powder and soak your feet in the water. As an alternative, you can glue mustard plaster to your calves, in the heart area.
2. Instead of a bath, lotions are used that are applied to the heels and feet. You need to moisten the compress in weak solutions of apple or wine vinegar.
3. Any chokeberry products (compotes, jam, etc.) help lower blood pressure.
4. A decoction of motherwort and valerian must be taken in case of nervous shock to avoid an attack.
5. Astragalus in the form of a decoction helps prevent a crisis if taken for a month.

Prevention

An attack with concomitant diseases can be prevented if you strictly follow the doctor’s recommendations and do not skip taking prescribed medications. Considerable attention should be paid to lifestyle changes: quitting smoking and alcohol, monitoring blood pressure levels, moderate physical activity.

You should avoid not only the abuse of bad habits, but also stress. These simple measures help a lot in preventing uncomplicated hypertensive crisis.

Complications

With prolonged absence of treatment, uncomplicated may develop into, in which target organs are damaged at the time of the attack. Often there is deterioration of vision, kidney damage, and sometimes advanced disease leads to a heart attack.

Forecast

Failure to provide timely assistance during a serious attack can lead to the development of a number of complications and even death.

The following video tells how to prevent the occurrence of a hypertensive crisis:

is a condition accompanied by a sudden critical increase in blood pressure, against the background of which neurovegetative disorders, disturbances of cerebral hemodynamics, and the development of acute heart failure are possible. A hypertensive crisis occurs with headaches, noise in the ears and head, nausea and vomiting, visual disturbances, sweating, lethargy, sensitivity and thermoregulation disorders, tachycardia, heart failure, etc. Diagnosis of a hypertensive crisis is based on blood pressure indicators, clinical manifestations , auscultation data, ECG. Measures to relieve a hypertensive crisis include bed rest, a gradual controlled decrease in blood pressure using medications (calcium antagonists, ACE inhibitors, vasodilators, diuretics, etc.).

ICD-10

I10 Essential [primary] hypertension

General information

A hypertensive crisis is regarded in cardiology as an emergency condition that occurs with a sudden, individually excessive jump in blood pressure (systolic and diastolic). Hypertensive crisis develops in approximately 1% of patients with arterial hypertension. A hypertensive crisis can last from several hours to several days and lead not only to the occurrence of transient neurovegetative disorders, but also to disorders of cerebral, coronary and renal blood flow.

During a hypertensive crisis, the risk of severe life-threatening complications (stroke, subarachnoid hemorrhage, myocardial infarction, ruptured aortic aneurysm, pulmonary edema, acute renal failure, etc.) increases significantly. In this case, damage to target organs can develop both at the height of a hypertensive crisis and with a rapid decrease in blood pressure.

Causes

Typically, a hypertensive crisis develops against the background of diseases occurring with arterial hypertension, but it can also occur without a previous persistent increase in blood pressure. Hypertensive crises occur in approximately 30% of patients with hypertension. The most common ones are:

• in women experiencing menopause
• with atherosclerotic lesions of the aorta and its branches,
• for kidney diseases (glomerulonephritis, pyelonephritis, nephroptosis), diabetic nephropathy, nephropathy in pregnant women.
• for systemic diseases: periarteritis nodosa, systemic lupus erythematosus;
• for endocrinopathies: pheochromocytoma, Itsenko-Cushing's disease, primary hyperaldosteronism;
• with the so-called “withdrawal syndrome” - quickly stop taking antihypertensive drugs.

In the presence of the above conditions, the development of a hypertensive crisis can be provoked by emotional arousal, meteorological factors, hypothermia, physical activity, alcohol abuse, excess consumption of table salt, electrolyte imbalance (hypokalemia, hypernatremia).

Pathogenesis

The mechanism of development of hypertensive crises in various pathological conditions is not the same. The basis of a hypertensive crisis in essential hypertension is a violation of neurohumoral control of changes in vascular tone and activation of the sympathetic influence on the circulatory system. A sharp increase in arteriolar tone contributes to a pathological increase in blood pressure, which creates additional stress on the mechanisms of regulation of peripheral blood flow.

Hypertensive crisis with pheochromocytoma is caused by an increase in the level of catecholamines in the blood. In acute glomerulonephritis, we should talk about renal (decreased renal filtration) and extrarenal factors (hypervolemia) that determine the development of the crisis. In the case of primary hyperaldosteronism, increased secretion of aldosterone is accompanied by a redistribution of electrolytes in the body: increased excretion of potassium in the urine and hypernatremia, which ultimately leads to an increase in peripheral vascular resistance, etc.

Thus, despite the various reasons, common points in the mechanism of development of various variants of hypertensive crises are arterial hypertension and dysregulation of vascular tone.

Classification

Hypertensive crises are classified according to several principles. Taking into account the mechanisms of increased blood pressure, hyperkinetic, hypokinetic and eukinetic types of hypertensive crisis are distinguished:

• Hyperkinetic crises are characterized by an increase in cardiac output with normal or decreased peripheral vascular tone - in this case, an increase in systolic pressure occurs.
• The mechanism of development of a hypokinetic crisis is associated with a decrease in cardiac output and a sharp increase in peripheral vascular resistance, which leads to a predominant increase in diastolic pressure.
• Eukinetic hypertensive crises develop with normal cardiac output and increased peripheral vascular tone, which entails a sharp jump in both systolic and diastolic pressure.

Based on the reversibility of symptoms, an uncomplicated and a complicated version of a hypertensive crisis are distinguished. The latter is said in cases where a hypertensive crisis is accompanied by damage to target organs and is the cause of hemorrhagic or ischemic stroke, encephalopathy, cerebral edema, acute coronary syndrome, heart failure, dissection of an aortic aneurysm, acute myocardial infarction, eclampsia, retinopathy, hematuria, etc. e. Depending on the location of complications that developed against the background of a hypertensive crisis, the latter are divided into cardiac, cerebral, ophthalmological, renal and vascular. Taking into account the prevailing clinical syndrome, neuro-vegetative, edematous and convulsive forms of hypertensive crises are distinguished.

Symptoms of hypertensive crisis

Neuro-vegetative form

A hypertensive crisis with a predominance of neuro-vegetative syndrome is associated with a sharp, significant release of adrenaline and usually develops as a result of a stressful situation. A neurovegetative crisis is characterized by excited, restless, nervous behavior of patients. Increased sweating, flushing of the skin of the face and neck, dry mouth, and hand tremors are noted. The course of this form of hypertensive crisis is accompanied by pronounced cerebral symptoms: intense headaches (spread out or localized in the occipital or temporal region), a feeling of noise in the head, dizziness, nausea and vomiting, blurred vision (“veil”, “flickering of flies” before the eyes) .

In the neurovegetative form of a hypertensive crisis, tachycardia, a predominant increase in systolic blood pressure, and an increase in pulse pressure are detected. During the period of resolution of the hypertensive crisis, frequent urination is observed, during which an increased volume of light urine is released. The duration of a hypertensive crisis ranges from 1 to 5 hours; There is usually no threat to the patient's life.

Edema form

The edematous, or water-salt form of hypertensive crisis is more common in overweight women. The crisis is based on an imbalance of the renin-angiotensin-aldosterone system, which regulates systemic and renal blood flow, the constancy of blood volume and water-salt metabolism. Patients with the edematous form of hypertensive crisis are depressed, apathetic, drowsy, and poorly oriented in the environment and in time. During an external examination, attention is drawn to pallor of the skin, puffiness of the face, swelling of the eyelids and fingers.

Typically, a hypertensive crisis is preceded by a decrease in diuresis, muscle weakness, and interruptions in heart function (extrasystoles). In the edematous form of a hypertensive crisis, there is a uniform increase in systolic and diastolic pressure or a decrease in pulse pressure due to a large increase in diastolic pressure. A water-salt hypertensive crisis can last from several hours to a day and also has a relatively favorable course.

Neuro-vegetative and edematous forms of hypertensive crisis are sometimes accompanied by numbness, a burning sensation and tightening of the skin, a decrease in tactile and pain sensitivity; in severe cases - transient hemiparesis, diplopia, amaurosis.

Convulsive form

The most severe course is characteristic of the convulsive form of hypertensive crisis (acute hypertensive encephalopathy), which develops when the regulation of the tone of cerebral arterioles is disturbed in response to a sharp increase in systemic blood pressure. The resulting cerebral edema can last up to 2-3 days. At the height of a hypertensive crisis, patients experience clonic and tonic convulsions and loss of consciousness. For some time after the end of the attack, patients may remain unconscious or disoriented; Amnesia and transient amaurosis persist. The convulsive form of a hypertensive crisis can be complicated by subarachnoid or intracerebral hemorrhage, paresis, coma and death.

Diagnostics

One should think about a hypertensive crisis when blood pressure rises above individually tolerable values, relatively sudden development, and the presence of symptoms of a cardiac, cerebral and vegetative nature. An objective examination may reveal tachycardia or bradycardia, rhythm disturbances (usually extrasystole), percussion expansion of the boundaries of relative dullness of the heart to the left, auscultatory phenomena (gallop rhythm, accent or splitting of the second sound over the aorta, moist rales in the lungs, hard breathing, etc.).

Blood pressure can increase to varying degrees; as a rule, during a hypertensive crisis it is above 170/110-220/120 mm Hg. Art. Blood pressure is measured every 15 minutes: initially on both arms, then on the arm where it is higher. When registering an ECG, the presence of cardiac rhythm and conduction disturbances, left ventricular hypertrophy, and focal changes is assessed.

To carry out differential diagnosis and assess the severity of a hypertensive crisis, specialists may be involved in examining the patient: cardiologist, ophthalmologist, neurologist. The scope and feasibility of additional diagnostic studies (EchoCG, REG, EEG, 24-hour blood pressure monitoring) is determined individually.

Treatment of hypertensive crisis

Hypertensive crises of various types and genesis require differentiated treatment tactics. Indications for hospitalization in a hospital include intractable hypertensive crises, repeated crises, and the need for additional research aimed at clarifying the nature of arterial hypertension.

If blood pressure rises critically, the patient is provided with complete rest, bed rest, and a special diet. The leading place in stopping a hypertensive crisis belongs to emergency drug therapy aimed at lowering blood pressure, stabilizing the vascular system, and protecting target organs.

1. Decreased blood pressure. To lower blood pressure values ​​during an uncomplicated hypertensive crisis, calcium channel blockers (nifedipine), vasodilators (sodium nitroprusside, diazoxide), ACE inhibitors (captopril, enalapril), ß-blockers (labetalol), imidazoline receptor agonists (clonidine) and other groups of drugs are used . It is extremely important to ensure a smooth, gradual decrease in blood pressure: by approximately 20-25% of initial values ​​during the first hour, over the next 2-6 hours - to 160/100 mm Hg. Art. Otherwise, with an excessively rapid decrease, the development of acute vascular accidents can be provoked.
2. Symptomatic treatment. Includes oxygen therapy, administration of cardiac glycosides, diuretics, antianginal, antiarrhythmic, antiemetic, sedatives, analgesics, and anticonvulsants. It is advisable to conduct hirudotherapy sessions and distraction procedures (hot foot baths, heating pads on the feet, mustard plasters).

Possible outcomes of treatment of hypertensive crisis are:

• improvement of condition (70%) – characterized by a decrease in blood pressure by 15-30% of the critical level; a decrease in the severity of clinical manifestations. There is no need for hospitalization; selection of adequate antihypertensive therapy on an outpatient basis is required.
• progression of hypertensive crisis (15%) – manifested by an increase in symptoms and the addition of complications. Requires hospitalization in a hospital.
• lack of effect from treatment - there is no dynamics of reduction in blood pressure levels, clinical manifestations do not increase, but do not stop. A change in medication or hospitalization is necessary.
• complications of an iatrogenic nature (10-20%) – occur with a sharp or excessive decrease in blood pressure (hypotension, collapse), side effects from medications (bronchospasm, bradycardia, etc.). Hospitalization is indicated for the purpose of dynamic observation or intensive care.

Prognosis and prevention

If timely and adequate medical care is provided, the prognosis for a hypertensive crisis is conditionally favorable. Cases of death are associated with complications arising from a sharp rise in blood pressure (stroke, pulmonary edema, heart failure, myocardial infarction, etc.).

To prevent hypertensive crises, one should adhere to the recommended antihypertensive therapy, regularly monitor blood pressure, limit the amount of salt and fatty foods consumed, monitor body weight, avoid drinking alcohol and smoking, avoid stressful situations, and increase physical activity.

For symptomatic arterial hypertension, consultations with specialized specialists - a neurologist, endocrinologist, nephrologist - are necessary.

Sharp jumps in blood pressure can occur in patients with hypertension, as well as in people who do not suffer from hypertension - due to stress, illness and the influence of unfavorable factors. It is recommended to treat a crisis that occurs for the first time in a hospital in order to accurately determine the reasons that caused it.

Hypertensive crises are a consequence of stress, as well as a sudden exacerbation of hypertension. They occur with disruption of the functions of the brain, kidneys, autonomic nervous system and blood flow in the coronary vessels. They are characterized by the risk of developing such serious complications as pulmonary edema, myocardial infarction, and stroke.

The causes of crises depend on many factors, ranging from genetic predisposition, lifestyle, hormonal imbalances, somatic diseases, harmful working conditions, psycho-emotional shocks. But the main factor is considered to be progressive arterial hypertension.

Crises are distinguished by types (1, 2):

1. Short-term. They are mild, as they stop quickly and go away in a few hours. The pressure rises to 180/110 mmHg. Art. There is pain in the back of the head and temples, trembling in the body, dizziness, facial flushing, a feeling of nausea, rapid heartbeat, and general agitation.
2. Long-term (severe). May last for several days. There are all the symptoms as in type 1, but also vomiting, numbness and tingling in the body, confusion and stupor.

Diagnosis of crises divides emergency conditions into 2 main types - complicated and uncomplicated. They can be presented in the form of the following table:

Indications for hospitalization are all complicated crises with rhythm and cardiac conduction disturbances, hypertensive encephalopathy, transient ischemic attack, cerebral circulatory disorders, acute coronary or left ventricular failure.

Patients with complications are hospitalized in the cardiology or neurology department or in the intensive care unit. They must undergo diagnostics.

For an uncomplicated crisis

IMPORTANT! Uncomplicated crises are subject to hospital treatment. If the attack occurs for the first time, is not stopped at the pre-hospital stage, and recurs within 2 days, there is a risk of complications from the heart and blood vessels.

Patients are hospitalized in the therapy department at their place of residence. Before the ambulance arrives and hospitalization, it is necessary to quickly provide assistance to the sick person in all available ways and try to relieve the hypertensive crisis:

1. Unbutton tight clothing, allow air access, and sit the patient so that the head is higher than the lower limbs.
2. Give one of the drugs (“Captopril”, “Nifedipine”, “Corinfar”, “Hypothiazide”, “Atenolol”, “Nitroglycerin”, “Farmadipine”, “Anaprilin”).
3. Place Validol under your tongue and drop 30 drops of Valocardin, Corvalol or valerian tincture.
4. You can put mustard plasters on your shins.
5. It is moral to calm the person down and not leave him alone.

Treatment of hypertensive crisis is carried out depending on the type of emergency condition. The doctor decides what kind of assistance to provide to the patient and where to start. Tactics and necessary diagnostics are selected.

The issue of parenteral use of medications (intravenously, into a muscle), place (at home, a therapeutic department or in an intensive care unit) is being decided. An anamnesis is collected and the causes of the crisis are determined, and appropriate methods of managing the patient are selected. For example, treatment for a pregnant woman and a stroke patient will be significantly different.

IMPORTANT! The purpose of inpatient drug treatment is to identify the possible cause of an emergency condition, normalize well-being, support cardiac output, renal blood flow, prevent and combat complications, select antihypertensive drugs (suitable for a particular patient), rapid and controlled reduction in blood pressure, taking into account adverse reactions.

For a complicated crisis

The stages of inpatient therapy for a crisis that occurs with complications include the necessary emergency care (after assessing the general condition) and conducting examinations. Treatment of a complicated hypertensive crisis begins with providing assistance to the patient at the prehospital stage.

Diagnostics involves performing the following necessary measures:

• Carrying out a general blood test (the number of leukocytes is important here; for example, hemolysis indicates the presence of a complicated form).
• Biochemical blood test (necessary to exclude uremia).
• A routine urine test during a complication will always indicate greater proteinuria and the presence of blood.
• Express test - the presence of sugar in the blood (necessary to detect hypoglycemia).
• ECG - indicates ischemic changes in cardiac activity.

They may also prescribe a chest X-ray (shows congestion of the pulmonary circulation), computed tomography (if the presence of cerebral circulatory disorders is suspected).

IMPORTANT! The prognosis can be unfavorable for the patient only in the absence of adequate therapy and in case of untimely consultation with a doctor. Taking antihypertensive drugs and their professional individual selection contributes to recovery and a low percentage of bad outcomes, even in complicated conditions.

Antihypertensive drugs for complicated hypertensive crises:

Name	Dosage (per kg)	Start (min)	Introduction	Action	Adverse reactions
"Nitroprusside"	Up to 10 mcg	3-5	IV drip	Removes all crises	Nausea, sweating
"Nitroglycerine"	Up to 200 mcg	5	IV drip	Myocardial ischemia, left ventricular failure	Headache
	20 mg every 5 min	10	IV stream or drip	All crises without left ventricular failure	Individual intolerance
"Nicardipin"	Up to 15 mg	5	IV drip	Crises without left ventricular failure	Hot flashes, nausea, palpitations
"Enalaprilat"	Up to 5 mg every 6 hours	12	IV drip	left ventricular failure, renal disorders	Sharp drop in blood pressure
"Phentolamine"	5-15 mg	1-2	I/O jet	Catecholamine crises	Head pain, tachycardia
"Hydralazine"	Up to 20 mg every 30 minutes	10-20	I/O jet	Eclampsia in pregnant women	Tachycardia, hot flashes, severe decrease in blood pressure
"Fenoldopam"	0.3 µg/min		IV drip	All crises, especially with kidney failure	Nausea, rapid heartbeat, hot flashes

Varieties of crisis with complications have their own characteristics in therapy, but are basically similar in the use of drugs to lower blood pressure and tactics:

1. Crises with neurological symptoms. Secondary neurological disorders may resolve after normalization of blood pressure.

Tactics: assessment of general condition, selection of medications, mandatory consultation with a neurologist, computed tomography. Until his condition normalizes, the patient is under observation in the intensive care unit. Monitor breathing and blood circulation. Tracheal intubation may be used. Among the antihypertensive drugs used intravenously, sodium nitroprusside, labetalol, nitroglycerin, hydralazine (for eclampsia in pregnant women), and fenoldapan (not for glaucoma) are used intravenously. These drugs are characterized by a long-lasting effect.

1. Malignant form. Is progressive.

Tactics: assessment of the condition, prescription of Nitroprusside, Labetalol. Diuretics are prohibited. Blood pressure is more than 181/106 and up to 235/122 mm Hg. Art., persisting for more than 1 hour - referral to the intensive care unit, treatment.

1. Dissecting aortic aneurysm.

Tactics: diagnosis, immediate decrease in blood pressure after assessing the condition and surgical intervention for A-form (proximal); for B-form (distal) - use of medications and observation. Labetalol or Nitroprusside are used.

1. Left ventricular failure and pulmonary edema.

Tactics: examination, assessment, use of Nitroprusside (Nitroglycerin), small doses of diuretics (Lasix, Furasemide).

1. Ischemic conditions of the myocardium.

Tactics: examination, assessment of the condition, clarification of the diagnosis using ECG diagnostics, use of nitrates, beta-blockers. If ineffective, Nitroprusside is prescribed. Antithrombotic drugs are used at the same time. Myocardial reperfusion is rarely performed. They use Obzidan (for tachycardia), Droperidol (for pain), and diuretics.

1. Catecholamine crises.

Tactics: Nitroprusside, Labetalol, Phentolamine, calcium antagonists, beta-blockers in combination with alpha-blockers.

1. Postoperative crisis.

Tactics: Nitroprusside, Labetalol, Nitroglycerin (if bypass surgery was performed).

1. Acute glomerulonephritis.

Tactics: examination, assessment of the condition, urine tests, use of beta blockers, diuretics (Furasemide, Maninila, Lasix), monitoring kidney activity.

IMPORTANT! In pregnant women during crises, intravenous administration of “Magnesium Sulfate” is used as a prophylaxis or treatment of convulsive syndrome.

In addition to the main hypertensive therapy, the patient is prescribed symptomatic medications: for nausea and vomiting - “Metoclopromide”; headache - any painkiller; autonomic disorders - Diazepam. Antihypertensive drugs such as Esmalol, Ebrantil or Urapidil are also used. The latter remedy consistently reduces blood pressure and has no side effects. This property is used with protocols for managing patients with crises, in accordance with current standards.

Treatment tactics for uncomplicated crisis

Therapy for an uncomplicated crisis is aimed at relieving the condition, stabilizing it, and maintaining therapy. Staying in a hospital is not always required here - you can treat a hypertensive crisis at home.

At home, you can take the drugs orally, with the dosage precisely calculated by your doctor and monitored by him. Treatment in the therapeutic department can be offered to the patient at his request, as well as if he has been diagnosed with hypertension, in order to complete the prescribed course of medication.

When a patient is admitted to a hospital with a hypertensive crisis, treatment is carried out for several hours, gradually reducing the pressure. Good indicators are reaching figures of up to -20%. Antihypertensive drugs are selected by the attending physician carefully, taking into account the patient’s age, body condition, concomitant diseases, and tendency to allergies.
This requires monitoring and control of blood pressure to avoid the development of a persistent hypotensive state.

How to treat an uncomplicated form of pathology? The ACE inhibitor Captopril (25 mg), the alpha-adrenergic receptor stimulator Clonidine (0.3 mg), and Labetalol (100 mg) are prescribed as antihypertensives. Symptomatic remedies are also prescribed.

IMPORTANT! Currently, the use of drugs such as Drotaverine hydrochloride (No-spa) and Papaverine, which do not have a pronounced hypotensive effect, is inappropriate, so they are not used in the treatment of hypertensive crises. All of the above medications are basic.

Stages of outpatient treatment

On an outpatient basis, with an uncomplicated form, the crisis is stopped based on the following principles:

1. Treatment measures are carried out after assessing the patient’s condition; Hypertensive therapy is prescribed.
2. The pressure is reduced gradually over the course of an hour, achieving a reduction in values ​​to 25% of the initial attack figures.
3. Helps prevent the development of complications from the heart and blood vessels.
4. Eliminate and reduce exogenous and endogenous factors.

Outpatient treatment is carried out with Nifedipine (Cordaflex) up to 20 mg, beta-blocker Propranolol 10-20 mg, ACE inhibitor Captopril up to 50 mg. This group of drugs consistently reduces high blood pressure levels within 30 minutes to 1 hour.

The stages and rules consist of providing emergency care, conducting diagnostics, selecting an antihypertensive drug (or replacing a previously prescribed one), applying symptomatic treatment, excluding a provoking factor, and monitoring the patient.

For outpatient treatment, folk remedies can be used in the form of plant herbs, which can be consumed in the form of infusions and decoctions.

IMPORTANT! If the patient has already taken any antihypertensive medication before starting therapy, the doctor must take this fact into account and prescribe an antihypertensive drug, taking into account the interaction with the previously taken drug.

Life after a hypertensive crisis

The patient’s recovery after a hypertensive crisis follows standard methods carried out by a therapist and psychologist.

Rehabilitation is necessary for the body due to the fact that after a crisis (even if blood pressure has recovered), a person may have a headache for quite a long time and his general well-being may suffer. Therefore, drug therapy, herbal treatment and a special diet with the exclusion of carbohydrates are used. The body also needs a lot of water and constant intake of antihypertensive drugs, which are selected specifically for each patient.

After a hypertensive crisis, the general condition of the patient is monitored by a therapist and a neurologist. Doctors recommend staying in bed for some time, and then starting moderate physical activity, which is necessary to improve blood supply to tissues and oxygen exchange. A little gymnastics in the morning, swimming, cycling, walking for half an hour tone the body.

Herbal medicine is based on the diuretic effect of herbal teas. Sedatives and consultation with a psychologist are prescribed (due to phobias and headaches). The help and support of loved ones, the elimination of stressful situations, positive daily activities and hobbies will not be superfluous.

The patient’s recovery should be accompanied by the intake of vitamin complexes, especially group B (for example, Neurovitan), as well as preventive measures that will help strengthen the body and prevent a recurrence of the crisis. It is advisable to give up bad habits (smoking, drinking alcohol or drugs). Sanatorium treatment at the resort will be useful. A change of environment, being in a medical dispensary, doctor's supervision, fresh air and special nutrition will help restore the body.

Patients must control their blood pressure, follow a rest and work schedule, monitor their weight, psycho-emotional state (avoid information neuroses), get enough sleep, eat vegetables and fruits, and exclude sweet, fatty and salty foods. The diet may include: cereals, fish, poultry, nuts, cottage cheese, cheeses.

If a person works at night, he needs to change his work schedule to a daytime one. It is better to replace noisy work with a quieter one. After consulting a doctor, the use of homeopathic medicines, acupuncture, relaxation methods, and breathing exercises is allowed. Physiotherapeutic methods are used (massages, vibroacoustics of the Vitafon apparatus), balneotherapy, and warm foot baths.

A hypertensive crisis is a condition of the body resulting from a sudden jump in blood pressure.

Important! One type of crisis is an uncomplicated hypertensive crisis.

The formation of a crisis is typical for people after 40 years of age. Sometimes it occurs in school-age children. During its development, target organs are not affected.

Peculiarities

A hypertensive crisis develops as a result of disturbances in the functioning of the cardiovascular system. There is a sudden increase in blood pressure.

An uncomplicated crisis occurs when the pressure level exceeds 240/140 mm. rt. Art. It is characterized by instant development and high pressure.

As a result, target organs are not affected: the brain, heart, kidneys, retina of the eyeball, blood vessels.

An uncomplicated hypertensive crisis can occur as a result of poor nutrition, psychological and physical stress, changes in weather conditions, injuries, and chronic diseases.

The symptoms of the pathology depend on the affected area:

1. Brain: headache, dizziness.
2. Cardiac: increased heart rate, shortness of breath.
3. Hypertensive crisis with paroxysms of hypothalamic origin: redness of the facial skin, frequent urination.
4. Increased blood pressure as a result of a severe burn.

Pathology can develop against the background of alcohol abuse and severe emotional stress.

Code in the International Disease Registry

Important! In medicine, there is a classification of all pathologies and diseases.

The classification system consists of assigning a special code to each disease.

This approach simplifies the system for searching for a specific dysfunction, speeds up the diagnostic process, and determines methods for further treatment.

According to the international classification, ICD 10 code is assigned to hypertensive crisis and its various forms and manifestations.

According to this code, there are 2 types of hypertension: primary, secondary.

Diseases that lead to increased blood pressure are assigned a separate code. According to the international registry, the code for a specific disease is entered into the patient’s medical history.

Causes

Important! Various factors can lead to the formation of an uncomplicated hypertensive crisis.

The main reasons for the development of the disease are:

• unbalanced diet: excessive consumption of fatty, fried foods, salt, strong coffee;
• psycho-emotional stress: stress, apathy, chronic fatigue;
• bad habits: alcohol, smoking;
• physical exercise;
• colds;
• injuries;
• surgical treatment;
• sudden change in climate and weather conditions.

The formation of an uncomplicated hypertensive crisis is observed against the background of various diseases:

• thyroid diseases;
• lupus;
• diabetes;
• polyarthritis;
• diseases of the cardiovascular system: atherosclerosis, arterial hypertension;
• hormonal disorders;
• kidney pathologies;
• nephroptosis.

The development of the disease can be caused by improper use and dosage of medications to lower blood pressure.

Symptoms

Important! The symptoms of a hypertensive crisis manifest themselves depending on the area of ​​damage to the cardiovascular system.

The main symptoms of the development of the disease are:

• headache, it can be concentrated in a certain area of ​​the head;
• nausea, vomiting;
• dizziness;
• impaired coordination, orientation in space;
• noise in ears;
• deterioration of visual acuity;
• high blood pressure;
• fever, chills;
• chest pain, difficulty breathing;
• rapid heartbeat, pulse;
• skin redness;
• pain in the heart area.

The duration of the crisis is no more than 3 hours. When the first signs of pathology occur, you must take antihypertensive drugs and consult a doctor.

Treatment methods

Therapy for an uncomplicated crisis consists of the complex use of therapeutic, medicinal treatment methods, and traditional medicine.

Therapeutic

The tactics of antihypertensive therapy for uncomplicated hypertensive crises is to calm the nervous system and relax the body. To reduce psychological and physical stress, meditation and physical therapy are prescribed.

Important! It is necessary to reconsider your diet.

Medication

Medications will help stabilize blood pressure and normalize the functioning of the cardiovascular system:

1. Calcium antagonists: Korenfar, Nifedipine. They help to quickly reduce pressure, relax blood vessels, thereby increasing their lumen.
2. ACE inhibitors: Captopril. Quickly stabilizes blood pressure and normalizes heartbeat.
3. Drugs to normalize the functioning of the cardiovascular system: Obzidan, Proxodolol. Relaxes blood vessels, improves blood circulation.
4. Sedatives: Valerian. Calms the nervous system, eliminates symptoms of nervous system disorders.

Folk remedies

Traditional methods of treatment will help stabilize high blood pressure and eliminate the manifestations of the disease.

1. Warm foot bath. Add a little mustard powder to a container with heated water. Feet should be immersed in water for a quarter of an hour.
2. Compress. A compress based on wine or apple cider vinegar is applied to the lower extremities;
3. Systematic use of decoctions, infusions, tea based on chokeberry, dill, astragalus, viburnum, .
4. Medicines based on motherwort and valerian are characterized by a sedative, calming effect.

Important! The course and methods of treatment are prescribed by a specialist, taking into account the reasons for the development of a hypertensive crisis, the individual characteristics of the body, which are entered into the patient’s personal data.

Preventive actions

In order to recover faster, preventive measures will help prevent the development of uncomplicated hypertension:

• proper nutrition: eat greens, dietary meats, fish, dairy products every day;
• practicing any sport: swimming, cycling, gymnastics, yoga and active walking;
• give up any type of smoking;
• correctly alternate physical and mental stress with rest;
• avoid various shocks;
• treat chronic diseases in a timely manner;
• systematically monitor blood pressure levels;
• take medications to normalize blood pressure.

Important! If characteristic symptoms of this crisis appear, you should consult a specialist.

Untimely treatment causes the formation of pathologies of damaged target organs, heart attack, stroke, and diseases of the cardiovascular system.

A hypertensive crisis is a sudden, persistent increase in blood pressure with symptoms and complications characteristic of this condition, primarily from target organs. The latter include the brain, heart, aorta - those organs, serious damage to which inevitably leads to the death of a person.

Causes and mechanism of development of hypertensive crisis

One of the most common questions that a hypertensive patient asks a doctor is the question of the causes of the crisis. The patient is perplexed because he carefully follows the regimen and dosage of prescribed medications. And to his surprise he finds out that a crisis may arise:

• due to severe psycho-emotional;
• sudden changes in weather, especially for weather-sensitive people.

However, the most common cause of a hypertensive crisis can be considered sudden discontinuation of antihypertensive drugs, failure to comply with medical prescriptions and inadequately selected dosages of drugs. The latter usually occurs at the very beginning of treatment (this will be discussed below).

A hypertensive crisis develops as a result of dysregulation of vascular tone due to a malfunction in the autonomic nervous system and excessive activation of hormonal mechanisms for maintaining blood pressure. Because of this, the concentration of catecholamines and vasopressin in the blood increases, hormones that increase blood pressure, as well as angiotensin II and aldosterone, which retain fluid in the bloodstream, increasing the volume of circulating blood.

Due to the need to pump increasing volumes of fluid, the heart begins to experience inadequate loads for it, and its need for oxygen increases. If the patient simultaneously has myocardial nutritional disorders, then at the peak of the crisis the development of left ventricular failure and arrhythmias is possible.

Excessive production of endothelin leads to disruption of the integrity of the vascular wall. If blood pressure is high, one of the blood vessels may burst, and if this happens in the brain, a hemorrhagic stroke develops. The development of its ischemic form is also possible due to prolonged vasoconstriction in any area of ​​the brain. This form is more favorable, but is also extremely dangerous for the life and health of the patient. Finally, a dissecting aortic aneurysm develops in a manner similar to a hemorrhagic stroke - the most dangerous complication of a crisis with a mortality rate close to 100%.

Symptoms of hypertensive crisis

Doctors divide any crisis into two categories - complicated and uncomplicated. In the first case, against the background of increased blood pressure, there are signs of damage to target organs - the heart, brain, aorta. In the second case there are no these symptoms.

• weakness (“can’t hold up your legs” is how patients describe this condition);
• dizziness;
• in the back of the head;
• visual artifacts (flickering “flies” before the eyes);
• noise in ears;
• nausea, sometimes with vomiting;
• chills;
• feeling of heat throughout the body;
• tachycardia or interruptions in heart function.

Not all of these symptoms necessarily appear in all cases, but complaints about at least some of them, especially if they do not occur for the first time, make one suspect a hypertensive crisis.

Diagnosis of hypertensive crisis

Making a diagnosis in the case of an uncomplicated crisis usually does not cause difficulties. It is enough just to measure blood pressure and compare it with the patient’s “working” pressure. Studying the anamnesis allows one to accurately identify both the crisis itself and the cause that caused it:

It is much more difficult, especially in the prehospital stage, to determine the symptoms of target organ damage. For this purpose, emergency doctors only have an electrocardiograph, which allows one to identify signs of myocardial ischemia.

However, a thorough examination and questioning of the patient helps in identifying signs of encephalopathy (nausea, vomiting, headache, confusion, visual disturbances), myocardial infarction (sternal pain, arrhythmias), acute left ventricular failure (shortness of breath, pale skin, wheezing). in the lungs), etc.

In a hospital setting the following can be carried out:

• chest;
• Ultrasound of the heart;
• lab tests.

These studies will not only establish the fact of damage to the target organ, but also determine how badly it was damaged.

Complications of hypertensive crisis

The most dangerous complications of a hypertensive crisis are acute coronary syndrome, dissecting aortic aneurysm, and stroke.

The mechanisms of their development are described above; the prognosis for these pathologies is very, very serious. That is why the ambulance responds to any call related to hypertension and does everything possible to stop the rise in blood pressure.

Treatment of hypertensive crisis

In an uncomplicated crisis, treatment does not present any particular difficulties. Often, patients, having independently detected a rise in blood pressure, take an additional dose of the drug prescribed to them and do not even consult a doctor. However, sometimes the effect is incomplete and then you have to call an ambulance or visit a local therapist.

The goal of treating a crisis is to bring systolic pressure to 139 or lower, and diastolic pressure to 99 or lower. Usually, this requires oral administration of one of the antihypertensive drugs - captopril, nifedipine, clonidine, metoprolol - coupled with taking a diuretic drug (most often furosemide). This is usually sufficient to stop the crisis. Hospitalization in such cases is not required.

Drugs used to relieve uncomplicated hypertensive crisis

Drugs	Doses and route of administration	Side effects	Start of action
Clonidine	0.075-0.15 mg orally or 0.01% solution 0.5-2 ml IM or IV	Dry mouth, drowsiness. Contraindicated in patients with AV block or bradycardia.	After 10-60 min.
Captopril	12.5-25 mg orally or sublingually	Orthostatic hypotension.	After 30 min.
Dibazol	1% - 4-5 ml IV 0.5% - 8-10 ml IV	More effective in combination with other antihypertensive drugs.	After 10-30 minutes.
Propranolol	20 - 80 mg orally	Bradycardia, bronchoconstriction.	After 30-60 minutes.
Droperidol	0.25% solution 1 ml IM or IV	Extrapyramidal disorders.	After 10-20 minutes.
Nifedipine	5-10 mg orally or sublingually	Headache, tachycardia, redness, possible development of angina.	After 10-30 minutes.

Important: Only your attending physician can select the exact dosage.

It is much more difficult to treat a crisis complicated by target organ damage. If in an uncomplicated form blood pressure should decrease gradually (up to 6 hours), then in a complicated form it must be stopped as quickly as possible. The reason is that the development of complications seriously worsens the prognosis of the disease and increases the risk of death tenfold.

In case of a complicated crisis, injectable forms of drugs are used:

1. Vasodilators:
   • enalaprilat (for left ventricular failure);
   • nitroglycerin (for acute coronary syndrome and left ventricular failure);
   • sodium nitroprusside (for hypertensive encephalopathy);
   • β-blockers (for ACS and dissecting aortic aneurysm);
2. Phentolamine (a drug that suppresses the activity of adrenaline in pheochromocytoma).
3. Diuretics (especially with left ventricular failure);
4. Neuroleptics (droperidol).

Doses of drugs are selected by doctors in such a way as to reduce blood pressure as quickly as possible.

note: Everyone's favorite magnesium (magnesium sulfate), which can have a very quick effect, is now used less and less. The reason is the available scientific data on a decrease in life expectancy in people whose hypertensive crisis was stopped with this drug. In addition, there are cases of a sharp jump in blood pressure after the end of the effect of magnesia and the development of severe complications.

Emergency care for hypertensive crisis

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