What is Hypertensive Crisis?

A hypertensive crisis is a severe and rapid increase in blood pressure that can lead to stroke. This sudden and extreme increase in blood pressure can rupture blood vessels leading to hemorrhage, stroke, and end-organ failure.

 

Hypertension is one of the most common systemic disorders across the globe. In the US alone, it affects more than 65 million people yearly [1]. Out of these, only 1% of hypertensive patients suffer from the hypertensive crisis. The initial symptoms of hypertensive crisis range from chest pain, headache, ultimately culminating in seizures and end-organ damage that may lead to death.

 

Acute hypertension or hypertensive crisis is commonly referred to as the ‘silent killer’ because, in most cases, it is either asymptomatic or shows very mild symptoms. Moreover, it also requires immediate medical treatment to prevent end-organ failure and death.

 

Hypertension is referred to as a Hypertensive crisis when the systolic blood pressure is higher than 180 mm Hg and diastolic blood pressure is equal to or higher than 120 mm Hg. Hypertensive crisis is also known as malignant hypertension or accelerated hypertension. It can cause various health complications that include angina, severe headache, heart failure, acute renal failure, and aneurysm. 

 

 

What are the Types of Hypertensive Crisis?

 

The hypertensive crisis is a broad term that covers various forms of hypertension. There are two types of hypertensive crisis [2]:

 

• Hypertensive Emergency: it is an acute elevation of blood pressure that can cause end-organ damage. It can cause pulmonary edema, cardiac ischemia, renal failure, etc. 
• Hypertensive Urgency: it is also an elevation of the blood pressure but it does not cause end-organ damage. Blood pressure usually returns to normal after taking blood pressure-lowering medicines.

 

 

 

 

What are the Signs and Symptoms of Hypertensive Crisis?

 

Signs and symptoms of hypertensive crisis can be life-threatening and vary from person to person in intensity. Following are some common symptoms [3]:

 

• Angina or chest pain
• Dyspnea or shortness of breath
• Nausea or vomiting
• Weakness
• Changes in sleep patterns
• Confusion
• Headache
• Blurred vision
• Anxiety
• Seizures

 

 

 

 

 

What are the Causes of Hypertensive Crisis?

 

Uncontrolled hypertension and non-compliance with the treatment prescribed by your health care provider are the main causes of hypertensive crisis. Hypertensive crisis is caused by both primary and secondary causes. Here is a brief description of each [4]:

 

1. Primary causes:

• Smoking
• Excessive alcohol consumption
• Genetics
• Old age
• Overuse of salt in the food
• High cholesterol diet
• Stress

 

1. Secondary causes:

• Renal dysfunction
• Hypothyroidism
• Hyperparathyroidism
• Adrenal glands disease
• Sleep apnea
• Tightening of the aorta
• Side effects of certain medications like NSAIDs, Stimulants, Immune system depressants, and diet pills.

 

Hypertensive crises may also occur due to drug-food reactions. For example, if people who are taking MAO (monoamine oxidase inhibitor) as anti-depressants eat tyramine-rich food items. The reaction results in a hypertensive crisis.

 

 

 

What are the Treatment Options for Hypertensive Crisis?

 

The basic purpose of treatment of hypertensive crisis is: 

 

• To control the end-organ damage
• To reduce blood pressure

 

Blood pressure-lowering medications: These drugs decrease blood pressure by directly acting on the blood vessels and the heart (cardiovascular system). Examples of blood pressure medications are amlodipine, verapamil, nifedipine, and esmolol. These include:

 

• Diuretics
• Nitro-glycerine
• Nitroprusside
• Nicardipine
• Esmolol
• Labetalol
• Hydrazine
• Angiotensin-converting enzyme (ACE) inhibitors

 

 

 

References:

1. https://journals.lww.com/cardiologyinreview/Abstract/2010/03000/Hypertensive_Crisis.10.aspx  
2. https://www.ncbi.nlm.nih.gov/books/NBK470371/#:~:text=These%20can%20include%20pulmonary%20edema,%2C%20aortic%20dissection%2C%20and%20eclampsia.
3. https://www.ncbi.nlm.nih.gov/books/NBK470371/#:~:text=Symptoms%20such%20as%20a%20headache,in%20vision%20warrant%20further%20evaluation.
4. https://www.ncbi.nlm.nih.gov/books/NBK470371/#:~:text=The%20majority%20of%20hypertensive%20emergencies,the%20body's%20innate%20autoregulation%20capacity.
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440310/#:~:text=labetalol%20(9).-,The%20drugs%20of%20choice%20in%20treating%20patients%20with%20a%20hypertensive,contraindicated%20in%20treating%20these%20patients.

 

 

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