Hypertensive Crisis

Hypertensive Crisis is a very acute disease affecting Hypertension patients across the world. Read and know all about this condition along with its causes, symptoms, diagnosis and treatment.

Hypertensive Crisis Definition

It is an extremely serious condition characterized by a severe rise in blood pressure that may cause a stroke. It may occur in people already suffering from hypertension or high blood pressure.

Hypertensive Crisis Incidence

The exact incidence of this condition is not known. Even though it affects less than 1% individuals with hypertension, it is believed to have a possible high incidence in future. This is due to the fact that Hypertension affects 50,000 people in the US every year. However, it is also often diagnosed in people who have not been previously detected with Hypertension or those with a poorly controlled Hypertension. Approximately half a million people in the US are said to suffer from this condition at some point or other in their life.

Hypertensive Crisis Symptoms

The condition arises when the blood pressure elevates to 180/110 mm of Hg or higher. However, there may even be cases where the blood pressure shoots up to 220/140 mm of Hg. In such cases, patients may suffer from damage and failure of multiple organs.

There are many sure signs and symptoms of Hypertensive Crisis (HC). These involve:

  • Acute, throbbing headache
  • Change in mental consciousness
  • Respiratory difficulties
  • Shortness of breath
  • Dysarthria (speech disorder)
  • Chest pain
  • Severe tightness in the chest
  • Heart palpitations, arising due to Arrhythmia

Hypertensive Crisis and Bleeding

If an increase in blood pressure causes bleeding or rupture of aneurysms and results in brain damage, patients may suffer from problems like seizures as well as heart attack and mental confusion. There may also be other difficulties like:

  • Inflammation of the brain
  • Fluid-filled lungs
  • Changes in behavior or mood

In worse cases, patients may also enter into a comatose stage.

Hypertensive Crisis and Pulmonary Edema

An increase in the flow of blood may cause accumulation of fluids in the tissues, thereby leading to inflammation or edema. When this happens inside the lungs, Pulmonary edema can develop as a consequence. This may give rise to a life-threatening complication.

Is Hypertensive Crisis An Emergency?

In acute stages, this condition can be regarded as an emergency. Patients with Pulmonary edema can be considered as emergency patients. Symptoms related with emergency cases of the disorder, such as respiratory shortness and chest compactness, may be noted upon examination. Doctors can find out the stage of the Hypertensive Crisis with physical examination and blood tests. However, any person experiencing breathing difficulties and severe headache should be treated as emergency HC patients. Although these symptoms are not enough to distinguish between urgent and emergency cases of HC, people exhibiting them should immediately be rushed into an emergency room.

It is absolutely necessary to cure this condition on an emergency basis. This is due to the fact that the disease may result in severe, life-threatening complications like:

  • Stroke
  • Kidney failure
  • Irreversible damage to multiple organs
  • Blood vessel damage (which may cause Internal Bleeding)

Due to these problems, the condition needs to be addressed at once. The blood pressure level needs to be brought down immediately so as to make sure that the condition does not lead to any long-lasting damage. In an emergency case, treatment should be much stronger in approach. Apart from reducing blood pressure levels with medicines, doctors should also check whether any organ damage has occurred. Once the condition has stabilized, operation may be conducted on one or more organs of the patient. Follow-ups and proper management of Hypertensive Crisis are required to prevent the development of any complications.

Hypertensive Crisis Causes

The condition may arise due to various causes, such as:

Hypertension medications

Sudden discontinuation of hypertension medicines can result in this disorder. This is particularly noted in people who suffer from labile hypertension or chronic high blood pressure.

Underlying disorders

Patients with underlying conditions like Primary glomerulonephritis, chronic pyelonephritis and a few types of renal parenchymal disorders may result in a sudden elevation in blood pressure.

Endocrine conditions

Endocrine disorders like Primary hyperaldosteronism, Cushing’s syndrome and Pheochromocytoma may also be responsible for an increase in the blood pressure.

Systemic conditions

Presence of systemic disorders like systemic sclerosis, systemic lupus erythematosus and vasculitides may also lead to a rise in the level of blood pressure.

Medications

Use of some medicines like amphetamines, cyclosporin and cocaine may also lead to a rise in blood pressure levels. Taking in Monoamine Oxidase Inhibitors (MAOI) along with Tricyclic antidepressants may also result in a drug interaction that can raise blood pressure. MAOI suppresses the metabolic decomposition of dietary amines. Sufficient intestinal inhibition may result in HC when there is an intake of foods containing Tyramine.

Post-operative hypertension

Hypertension occurring after operation may also give rise to a case of HC.

Eclampsia

In pregnant women, a rapid and uncontrollable elevation in the blood pressure levels may cause a medical complication referred to as “Eclampsia”.

Hypertensive Crisis Diagnosis

Diagnosis of this condition usually begins with doctors asking patients about their lifestyle and medical history to get a better understanding of the disease. Patients are also asked about any recent operation that they have undergone. Patients should also inform healthcare providers about any dietary or herbal supplements or any recreational and nonprescription drugs that they might have been lately using.

Doctors may also perform urine and blood tests to assess organ damage and monitor blood pressure. Blood pressure should be regularly monitored in HC patients. An eye examination should also be conducted to detect any internal inflammation or bleeding.

Hypertensive Crisis Differential Diagnosis

Certain disorders may cause symptoms similar to the ones resulting from HC. Differential Diagnosis focuses on finding out whether patients are really suffering from HC or such similar conditions, such as:

  • Acute Stroke
  • Acute Aortic Dissection
  • Acute Left Ventricular Failure
  • Acute Myocardial Infarction (or Unstable Angina)
  • Eclampsia
  • Hypertensive Encephalopathy
  • Preeclampsia

Hypertensive Crisis Treatment

If doctors view the condition as urgent, they usually administer patients with blood pressure medications by injection or intravenous drip. The condition of the patients is monitored for several hours to make sure that there is sufficient reduction in blood pressure levels. If patients show good response to medications, physicians may arrange for better hypertension control measures or follow-up with family doctors in the future.

If not cured on a priority basis, Patients with a blood pressure level over 180/110 mm of Hg are highly susceptible to organ failure. Due to this, they need to be immediately hospitalized and treated with aggressive parenteral therapy. This will instantly help bring down the level of blood pressure as well as address the symptoms exhibited by the patient. Cardiac and Neurologic tests may also be conducted to detect any type of damage to the brain or the heart. The treatment for any abnormalities in other organs may be done only after stability has restored in the blood pressure level of the patient.

Once the blood pressure level has been reduced, patients may change to oral medicines that help them maintain the level of blood pressure.

Hypertensive Crisis Prognosis

In the absence of therapy, the condition is found to have a poor outcome. In 10-20% cases, patients manage to survive only up to a year. However, the use of Current Antihypertensive Therapy has been found to improve chances of survival. Approximately 70% patients receiving proper treatment are found to show a 5-year survival rate. On diagnosis, renal failure is found to increase the rate of mortality.

When Hypertensive crisis is classified as an emergency, it is generally considered to be highly serious. In such cases, patients may take a long time to recover in the hospital.

Hypertensive Crisis Complications

The condition can give rise to a number of complications, such as:

Cardiac impairment

Myocardial damage often results from a Hypertensive emergency and causes subsequent heart failure which leads to death of sufferers.

Neurological deficit

Events such as haemorrhage, hypertensive encephalopathy or cerebrovascular accident may result in permanent neurological compromise in patients. This is often found to cause death of patients.

Renal impairment

Hypertensive emergency frequently gives rise to renal insufficiency and failure.

Hypertensive Crisis Prevention

The best measure to prevent this condition is to take anti- blood pressure medicines as per directions. In case of any HC symptoms, medical attention should be sought as soon as possible. Avoiding stress through regular light workouts and medical checkups can also help one avert this condition.

Pulmonary Hypertensive Crisis

It is a condition marked by an increase in pulmonary artery pressure related with various disorders and other causes. This is a progressive disorder that may give rise to severe complications, such as

  • RV failure
  • Arrhythmia
  • Chronic hypoxia
  • Acute lung injury (like Vascular Obilteration, Hypoxemia, buildup of Cellular Debris and Fibrin)
  • Death

The symptoms are based on the severity of the disease and the age at which they manifest.

The syndrome results from various causes, such as:

  • Elevated resistance in the Precapillary Pulmonary Vessels
  • Heightened flow of pulmonary blood (into a healthy vascular bed)
  • Unusual resistance in the Postcapillary Vascular Bed (vascular obliteration, obstruction or constriction)

Patients aged within 18 months and having other conditions like Asplenia, Bronchiolitis, Diaphragmatic hernia, Sickle cell disease and Thalassemia are particularly susceptible to this disorder.

If you are suffering from an acute rise in blood pressure levels, seek medical attention immediately. As aforesaid, the condition can have fatal consequences in the absence of treatment. Therefore, the earlier you receive treatment the better it will be for you.

References:

http://www.mayoclinic.com/health/hypertensive-crisis/AN00626

http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertensive-crisis

http://emedicine.medscape.com/article/1952052-overview

http://bestpractice.bmj.com/best-practice/monograph/27/follow-up/prognosis.html

Published on December 22nd 2011 by  under Heart, Blood and Circulation.
Article was last reviewed on 17th January 2012.

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