It is an increase in blood pressure without damage to the target organs.
The terms previously used in hypertensive crises, such as accelerated and malignant hypertension, have now been replaced by hypertensive and hypertensive emergencies.
These are differentiated by the occurrence or otherwise damage to organs commonly white.
Blood pressure above 180 mm Hg systolic and 120 mm Hg diastolic is generally considered severe hypertension.
This designation includes both hypertensive emergency and hypertensive emergency.
A hypertensive emergency is one in which the elevation of blood pressure is not accompanied by injuries to the target organs of this disease.
These elevations do not cause death immediately, so it is possible to gradually bring these blood pressure levels (24 to 48 hours) to normal levels.
There are also false hypertensive emergencies; these blood pressure elevations are characterized by a sudden rise in diastolic blood pressure above 120 mmHg.
It presents mild symptomatology or, in many cases, is asymptomatic and does not produce damage to the organs; they are caused by painful syndromes, anxiety situations, or processes of any other nature.
This blood pressure normalizes when the stimulus ends and does not require specific hypotensive treatment.
External causes of the hypertensive crisis:
- Stress and strong emotions.
- Use of hormones
- Intense physical activity
- Changes in climate, such as excessive heat.
- Smoking and exaggerated consumption of alcohol.
- Consumption of excessive amounts of salt.
Among the external causes:
- Hormonal changes during menopause.
- Problems with the excretion of urine.
- Complications of ischemic heart disease.
- Poor supply of blood to the kidneys.
- Apnea-hypopnea syndrome.
The main symptom is exceptionally high blood pressure, maximum or systolic pressure of 180 mm Hg or more, and a minimum or a diastolic pressure of 120 mm Hg or more.
Before proposing the treatment, the critical point is to establish the differential diagnosis, discriminating if it is a genuine crisis or hypertensive emergency, supported by physical exams and complementary examinations.
The evaluation of the patient with an elevation of the arterial pressure is oriented to discard the existence of the injury in a white organ, to be able to differentiate the emergencies from the hypertensive emergencies.
In a hypertensive emergency, the treatment will depend on the diseases that are associated and in two situations:
- In the case of patients who had not been diagnosed with the disease and did not usually receive antihypertensive drugs. Treatment should be initiated with any available drug.
- In the case of patients with chronic diseases and who received antihypertensive treatment. It will be verified that the doses and dosing intervals are correct, an adjustment of the treatment will be carried out, or another drug of synergistic action will be associated.
Once it has been established that you are in the presence of a hypertensive emergency, ruling out damage to target organs.
The main objective will be gradually reducing blood pressure, as established by the hypertensive emergency guidelines.
These recommendations include oral but fast-acting antihypertensive treatment such as labetalol, clonidine, or captopril for a gradual decrease in pressure over 24 to 48 hours.
Then the resting prescription is prescribed, long-acting antihypertensive drugs by oral route and control of all the endogenous and exogenous triggers.
In patients without a history of hypertension, oral antihypertensive treatment should be initiated with blood pressure monitoring to make treatment adjustments.
Hypertensive crises are usually controlled with a single drug and should meet the following requirements:
- Possess an immediate and sustained antihypertensive effect.
- Do not decrease blood flow at the cerebral or coronary level.
- Easy dosage and administration.
- Minimal side effects
The crisis follow-up should be scheduled, by monitoring blood pressure, with possibilities of changing treatment, recommendations to the patient regarding adherence to treatment, weight loss, exercises, consumption of fat-free foods, and a little salt.
Key elements to prevent recurrences and optimize overall treatment compliance.
- Confirm that the patient is stable, improved, and has no symptoms.
- The patient should be followed up, which involves evaluation of signs.
- Evaluation of treatment adherence.