Hypertensive Crisis: Types, Causes, Symptoms, Diagnosis, Treatment, Risk Factors and Precautions

It is an alteration of blood pressure, this represents a serious risk that can cause a range of injuries to target organs.

A blood pressure that results in a hypertensive crisis refers to readings that are above 180/120 mmHg and can cause damage to the blood vessels.

When blood pressure rises, the heart has difficulty pumping blood efficiently.

Therefore, the hypertensive crisis should be treated immediately to reduce the risks of stroke, heart attacks, as well as other events and complications related to the circulatory system.


This hypertensive event can be treated as a hypertensive emergency or as a hypertensive emergency, the difference lies in the involvement of white organs.

1. Hypertensive urgency

In the hypertensive emergency, the blood pressure readings are higher than 180/110 mm Hg, but there are no associated organic damages.

For its treatment, only a change in the oral treatment is required, in case of not presenting the symptoms beforehand and lacking a medical prescription, an evaluation is made to recommend a treatment.

When hypertensive emergencies occur, monitoring should be recommended, rest should be prescribed, a specialist must control the triggering illnesses and prescribe a new treatment that allows correction within a period of 24 to 48 hours.

2. Hypertensive emergency

In the hypertensive emergency, the application of parental treatments is necessary, in this case there are acute alterations in the target organs such as brain, heart and kidney.

This requires a drop in blood pressure immediately, in a maximum period of one hour.

In this type of crisis there is a high risk of the occurrence of a stroke, myocardial infarction, loss of consciousness and even memory loss, loss of kidney function, angina pectoris, pulmonary edema, damage to the eyes and eclampsia.


The most common causes of the onset of a hypertensive crisis, is not taking the corresponding doses of prescribed treatment for blood pressure, stroke, heart attack, heart failure, kidney failure, rupture of the aorta, drug interactions and eclampsia.

Other causes that can cause a hypertensive crisis are: pre and post operative hypertension of transplant patients, a renal or cardiac insufficiency, abuse in the use of cocaine, an underactive or overactive thyroid, hypertension caused by pregnancy such as preeclampsia and eclampsia , alcohol abuse, burns, head injuries, surgery or trauma, the combination of certain medications, among others.


The symptoms will depend on the degree of involvement, therefore the symptoms of a hypertensive emergency include: shortness of breath, severe anxiety, headache, nausea or vomiting, dizziness or weakness.

Severe symptoms of a life-threatening hypertensive emergency are severe chest pain, bleeding or bleeding from the ears and / or nose, severe headache accompanied by confusion, behavioral changes such as drowsiness and forgetfulness, severe headache which may be accompanied by blurred vision, nausea and vomiting, severe anxiety, difficulty breathing, seizures and lack of response.


The objective of the diagnosis of the hypertensive crisis is to identify the causes and assess the possible damage.

A diagnosis of the history should be made as the presence of other conditions: high blood pressure, heart disease or diabetes.

A review of medications used with or without a prescription, including natural medicines, or dietary supplements, should be conducted.

A comprehensive medical examination will be performed, including blood pressure measurement, cardiopulmonary auscultation and peripheral pulse data, abdominal examination and tests to evaluate the functions of target organs, such as brain, heart and kidney.

The diagnostic tests commonly used to evaluate hypertensive crises include:

  • Monitoring of blood pressure.
  • Laboratory tests to determine the proper functioning of the liver, pancreas and kidneys.
  • Eye exam as fundus and revision of swelling and bleeding.
  • Tests of strength, balance, reflexes and memory.
  • EKG, chest x-ray that can show signs of heart failure or fluid around the heart and lungs.
  • Computed tomography, the images may show signs of a stroke.
  • Kidney tests, ultrasound, urography, scintigraphy, to look for evidence of kidney problems.


Hypertensive crisis is often treated with rest and the application of diuretics and blood pressure medications, these help control enzymes that inhibit the production of endogenous vasoconstrictor substances and reduce excess fluid that accumulates in blood vessels, which decreases your blood pressure by reducing the pressure in your arteries.

Should be performed in cases of hypertensive emergency, monitoring of blood pressure and heart rate, administered via peripheral venous glucose with 5% glucose at 7 drops / min, if there are no diabetes, should be assessed periodically the level of consciousness and neurological constants, place a bladder catheter for diuresis time measurement.

Recommended medications:

  1. Sublingual drug supply, currently it is usual to use nifedipine or captopril.
  2. Intravenous administration of a diuretic, the one used regularly is furosemide.
  3. In case of not achieving the desired effects, labetalol or urapidil is used orally, with constant monitoring, advising that said drug be applied in an observation room. You can also use enalapril from 0.5 to 2 mg applied every 30 minutes.
  4. And other specific medications when hypertension is caused by other pathologies.

To prevent the occurrence of another hypertensive crisis, it is important to prescribe treatments for other health conditions that generate these crises, such as diabetes or heart disease among others.

Risk factors and precautions

When you suffer from blood pressure, or a disease that triggers alterations in blood pressure levels, there is a risk of suffering a hypertensive crisis and as a result a stroke, a heart attack or kidney damage.

So you must control certain risk factors such as:

  • The lack of taking the medication for blood pressure as directed by your doctor or the asymptomatic appearance of the disease.
  • Emergence of mild hypertension problems caused by pregnancy (preeclampsia, eclampsia), uncontrolled
  • Suffering from thyroid diseases, kidney or adrenal diseases, heart disease or stroke.
  • Use of cocaine or any amphetamine.
  • Abusive use of cigarettes or alcohol.

Among the precautions that must be taken to avoid a hypertensive crisis we have:

  • Other health conditions such as thyroid disease, adrenal problems or diabetes should be checked periodically or before the onset of symptoms. These conditions can cause or worsen a hypertensive crisis.
  • Constant monitoring of blood pressure, keeping a record of blood pressure readings.
  • Intake of a variety of healthy foods, such as vegetables, fruits, low-fat dairy products, beans, lean meats, whole-grain breads and fish, limit the amount of sodium and fat that are ingested. It may also be necessary to ingest foods with high potassium content.
  • Maintain a healthy weight, with the help of diets recommended by your treating doctor and perform regular exercises.
  • Limit alcohol consumption.
  • No Smoking.


The consequences of an uncontrolled hypertensive crisis can be:

  • Diseases of the heart: A hypertensive crisis causes a continued effort in the heart muscles to maintain the blood pumping, which can cause angina, an increase in the size of the heart and even a heart attack.
  • Cardiovascular accidents: Product of the narrowing of the arteries, caused by the hypertensive crisis, this condition can cause thrombosis or hemorrhages in areas close to where the injury occurs.
  • Damage to vision: Elevated levels of blood pressure can affect the eyes, producing renopathy, which is responsible for the rupture of small arteries in the eyes, which in some cases can cause total loss of vision.
  • Damage to the kidneys: Due to these high levels of blood pressure, it can lead to paralysis of your kidney functions and in some cases even to the loss of these.
  • Damage to the lungs: edema may occur due to the rupture of the capillaries in the lungs, which cause the entrance of fluid into the lungs.
  • Damage to the brain: The delicate circulatory network of the brain can suffer ruptures, which can cause partial or total brain damage, which results in the loss of motor functions and in some cases in brain death and therefore a vegetative life.

In view of the possible consequences of a hypertensive crisis and given that in most cases it is a silent disease, which produces no symptoms, periodic medical monitoring is necessary to make a diagnosis of its existence in time and achieve early prevention of the disease and its effective control.