Hypertensive Crisis Overview

Definition and Types

• Hypertensive crisis is a severe elevation in blood pressure that requires immediate medical attention.
• It's characterized by blood pressure readings typically exceeding 180/120 mmHg.
• Two main types: hypertensive urgencies and hypertensive emergencies.
• Hypertensive urgencies: blood pressure is severely elevated, but there's no immediate, direct, and/or impending organ damage.
• Hypertensive emergencies: blood pressure is severely elevated, and there's evidence of ongoing or imminent organ damage.

Symptoms and Diagnosis

• Symptoms: Symptoms vary depending on the specific organ involved and the severity of the elevation. Headache, dizziness, visual disturbances, shortness of breath, chest pain, and altered mental status are possible.
• Diagnosis: Diagnosis involves taking a thorough medical history, conducting a physical examination, and obtaining blood pressure readings. Further testing may include checking blood tests, kidney function, and monitoring for presence of organ-specific symptoms.

Complications and Management

• Complications: Untreated hypertensive crisis can lead to a range of severe and life-threatening complications, including stroke, heart attack, acute kidney injury, and seizures.
• Management: Immediate management is crucial. Treatment aims to rapidly lower blood pressure without causing further harm to the body's organs. Hospitalization is nearly always preferred for close monitoring and care.

Treatment Options

• Treatment: Treatment strategies vary depending on the type of hypertensive crisis (urgency versus emergency).
• Hypertensive emergencies: often require intravenous medications to rapidly lower blood pressure while monitoring for organ damage. Careful protocols and continuous blood pressure monitoring are necessary.
• Hypertensive urgencies: may be managed by oral medications to gradually lower blood pressure over a period of hours, but monitoring is still vital.

Causes and Risk Factors

• Causes: A range of factors can contribute to the development of hypertensive crises, including underlying conditions like uncontrolled hypertension, certain medications, and substance abuse. Renal disease, pregnancy-related conditions, and severe stress situations are sometimes contributing factors.
• Risk factors: Pre-existing hypertension, poorly controlled conditions such as diabetes or kidney disease, certain types of medications, recent discontinuation of antihypertensive medications, and illicit drug use can increase the likelihood of developing a hypertensive crisis.
• Certain medical conditions (such as pregnancy or certain illnesses) can also increase the risk.