Hypertensive crisis is sudden disorder of blood circulation which arises against the background of a hypertension. In a hypertension the mechanisms of regulation of arterial blood pressure work with big tension and is not always effective. For this reason in a hypertension; any irritating factor can lead to deep disturbance of work of the vascular system and critical increase in arterial blood pressure. The majority of cases of hypertensive crisis is provoked by the emotional stress, weather changes, overfatigue increased by physical activities and so forth. In development of hypertensive crisis an important role is played by disturbance of the central link of regulation of arterial blood pressure (the centers of regulation of arterial blood pressure located in a brain). Can be other causes of hypertensive crisis cancellation of intake of medicines prescribed from pressure, an alcohol abuse.
Symptoms of hypertensive crisis
- The squeezing or arching nape pain, with feeling of a pulsation in temples
- The disorder of vision in the form of "flashing of front sights" before eyes, can be loss of fields of vision (partial blindness)
- Nystagmus (trembling of eyeballs)
- The nausea or vomiting which is not giving relief
- Reddening and temperature increase of the person, some patients speak "the person burns"
- Shiver, fever
- Contagious and motive excitation
- Fear, panic
- Discomfort, in a thorax or gripping pains behind a breast
- Feeling of shortage of air and asthma
- Cardiopalmus or "interruptions" in heart
- Tremor (trembling) of hands
- Sometimes lack of coordination of movements, unsteadiness of gait and spasm
- The increased perspiration
Classification and types of hypertensive crisis
The standard classification of hypertensive crises it is at the moment not created because of a huge variety of manifestations and complications which hypertensive crisis can give. The simplest classification of hypertensive crises which is widespread includes two of its views: the uncomplicated and complicated hypertensive crisis .
Uncomplicated hypertensive crisis usually arises at early stages of a hypertension (I, II stages). Level of arterial blood pressure in uncomplicated hypertensive crisis increases suddenly and quite considerably, but at the same time signs of damage of target organs are absent. The brain blood stream can be temporarily complicated, disturbances of a hormonal background (for example, there is a strong emission of adrenaline ) and neurovascular disturbances are observed. Among symptoms of uncomplicated hypertensive crisis those which are caused by directly sharp increase in arterial blood pressure prevail , sometimes symptoms of disturbance of a local brain blood-groove join them. Development of hypertensive crisis of an uncomplicated type usually takes place violently, but its duration is small (usually it does not exceed 2 — 3 hours), and it is easily stopped by means of antihypertensive drugs ( that is the drugs reducing pressure).
The complicated hypertensive crisis develops at later stages of a hypertension (II, III stages). This type of hypertensive crisis is characterized not only sharp and strong increase at sick arterial blood pressure , but also significant damages of target organs. At the complicated hypertensive crisis complications from a cardiovascular system are especially frequent . Others the hypertensive crises complicated by hypertensive encephalopathy meet more often. Hypertensive or hypertensive encephalopathy is the disease caused by disturbance of blood supply of a brain because of narrowing of his arteries. Hypertensive encephalopathy is in turn dangerous by complications among which it is possible to call a stroke, Parkinson's disease , decrease in intelligence. Except hypertensive encephalopathy, hypertensive crisis can be complicated by other diseases, among them there are an ischemic stroke, wet brain, a fluid lungs, a myocardial infarction, an acute renal failure , retina hypostasis , etc.
The complicated hypertensive crisis, unlike uncomplicated, develops gradually, and its symptoms remain within several days even after arterial blood pressure was reduced.
Treatment of hypertensive crisis
At treatment of patients with hypertensive crises the doctor is faced by two tasks:
- to quickly stop crisis as there is always a risk of emergence of dangerous complications;
- to prevent developing of the subsequent crises.
Now there are very active drugs which can reduce arterial blood pressure in 1 - 5 minutes, but treatment of them does not exclude risk therefore it is necessary to know their properties, side effects and special indications.
But there is other group of means with gradually coming action (within 30-60 min.).
The choice of drug and method of administration depend on the speed with which it is desirable to receive decrease in the ABP, and from assessment of a clinical condition of the patient taking into account age, presence of atherosclerosis of various localization, heart failure, brain focal symptoms. At elderly patients (especially at hypokinetic type of a hemodynamics) too rapid decrease in the ABP as it can lead to ischemic disorders in vitals is undesirable (in a brain, heart, kidneys).
Tactics of faster lowering of arterial pressure is reasonable at early stages of a hypertension and also at the complicated forms of crises for elimination of an acute left ventricular or coronary failure, hypertensive encephalopathy, but also in these cases very careful decrease in the ABP is necessary (diastolic to 100-110 mm Hg.) as excessive falling of arterial blood pressure (more than for 25%) can cause heavy disorders of an autoregulya-tion of cerebral circulation or decrease in sokratitelny function of heart.
1) Treatment of crises of the first type
In the first type of crises means of the choice for stopping is Dibazolum entered intravenously (3-5 ml of 1% of solution). In hyperkinetic option of crisis and at elderly people Dibazolum reduces warm emission due to reduction of venous return of blood. At late stages of a hypertension at hypo - and eukinetichesky options of a hemodynamics Dibazolum promotes a smooth lowering of arterial pressure due to reduction of the general peripheric resistance. Intramuscular injections of Dibazolum are less effective, but it is possible to increase their efficiency, combining Dibazolum with Seduxenum.
The good effect is observed at many patients after intramuscular administration of rausedyl (1 ml of 1% of solution). It is especially shown to patients with the significant psychocontagious excitation. Arterial blood pressure decreases in 30-50 minutes. Rausedyl sometimes causes deep oppression of the central nervous system (slackness, block) that can mask development of disturbances of cerebral circulation. It is also necessary to consider that at the patients receiving regular treatment by beta blockers, rausedyl can cause overshot hypotensive effect and sharp bradycardia.
For stopping of crises with pronounced diencephalic symptomatology the good effect gives Droperidolum of 1 - 1.5 ml. In 15-30 minutes after intramuscular introduction the fever, a shiver, sensation of fear, nausea, vomiting disappear, often there comes the dream. High doses (2 ml) quite often cause excessive neurovegetative braking. It is good to combine Droperidolum with Dibazolum.
It is better to refrain from use of aminazine as its action is not always managed, it can cause excessive falling of arterial blood pressure in 30-40 min. after intravenous administration, collapse, sharp tachycardia and oppression of a respiratory center.
Beta blockers are inexpedient to be used for stopping of hypertensive crisis as in crisis the hemodynamics is characterized by sharp increase in the general peripheric vascular resistance and reduction of warm emission. Even patients with hyperkinetic type have a hemodynamics, with a high minute volume the administration of Obsidanum did not cause decrease in the ABP and stopping of crisis, at the same time addition of 0.3-0.5 ml of 5% of solution of Pentaminum was required.
2) Treatment of crises of the second type
At treatment of crises of the second type the doctor should reckon with a number of features. Weight and duration of cerebral and cardial crises at patients with a hypertension of II and III stages, most likely, are connected with atherosclerosis of brain and coronary arteries. Quite often elimination of a hypervolemia and wet brain, an attack of stenocardia, heart failure is required.
The best means for stopping of similar crises is clonidine. After intramuscular introduction of 1 ml of 0.01% of solution of clonidine the arterial blood pressure decreases due to decrease in OPS in 10-20 minutes, its maximum decrease is noted in 30-45 minutes, and the effect remains from 2 to 8 hours. Only in isolated cases the repeated intramuscular or intravenous administration of 0.5-1 ml of clonidine in 10 ml of normal saline solution is required. At the same time clonidine is entered into a vein slowly within 5-10 minutes or by drop infusion.
In house conditions it is possible to appoint clonidine inside or under language in a dose of 0.075-0.15 mg, to make a heat foot bath, to put mustard plasters on a nape and on calves. The essential lowering of arterial pressure comes in 30-60 minutes.
In the crises complicated by an acute left ventricular failure ganglioblokator are shown (reduce before - and a myocardium afterload). Use intravenous slow fractional administration of 5% of solution of Pentaminum or 2.5% of solution of petrolhexonium more often (0.3-0.75 ml in 10-20 ml of normal saline solution). At intramuscular introduction the hypotensive action of ganglioblokator develops in 10-30 minutes.
At hypertensive crisis with encephalopathy, the phenomena of wet brain and likvorny hypertension the use of diuretics (40-80 mg of furosemide or lasixum) intravenously and also magnesium sulfate (25% of solution of 10 ml) intramusculary is shown.
Complications of hypertensive crisis
Hypertensive crisis is not a just sudden sharp increase in the ABP which is followed by a headache. Hypertensive crisis has risk of various complications from many systems and bodies.
- Disturbances from the central nervous system in the form of stupefaction or a coma (encephalopathy)
- Hemorrhage in a brain
- Heart failure
- Fluid lungs (which is result of sudden insufficiency of a left ventricle)
- Myocardial infarction
- Eclampsia (it is noted during pregnancy)
Prevention of hypertensive crisis
In a hypertension it is better to refuse alcohol absolutely. Many cardiovascular drugs and alcohol are not compatible: effect of drug is weakened, and protection decreases.
Men in day can use no more than 50 g of vodka or 200 g of dry wine (it is better red) or beer half of liter. For women the dose of alcohol has to be reduced half.
It is known that smoking accelerates development of atherosclerosis, promotes increase in pressure, reduces oxygen content in blood, increases number of warm reductions. Many consider that if to leave off smoking, then there will be a severe stress which is even worse than smoking. This delusion. Those who has a sore heart need to refuse cigarettes that will bring undoubted benefit as the risk of cardiovascular complications at the same time quickly decreases.
Morning exercises, swimming, the bicycle, pipits or skis, daily walking in the fresh air 40 minutes tone up an organism and restore health. In a hypertension it is not necessary to be engaged in heavy dumbbells and a bar. The fact is that excessive physical exercises can lead to serious complications.