Complications of a hypertensive crisis

In most cases, if primary arterial hypertension is diagnosed, the patient himself provokes a hypertensive crisis, not following medical prescriptions. Such actions of the patient can lead to a critical condition:

  1. Violations of the regimen of drugs prescribed by a doctor.
  2. Change the dosage of the drug.
  3. Reception of non-steroidal analgesics and other medicines incompatible with antihypertensive drugs.
  4. Excessive intake of salt, caffeine, or alcohol.

If treatment is carried out incorrectly and irregularly, there are all prerequisites for the fact that at the first coincidence of adverse factors, a complicated or uncomplicated hypertensive crisis will develop. Crisis can occur with secondary hypertension. In this case, it provokes:

  • Itsenko-Cushing’s syndrome;
  • Renal artery stenosis;
  • Acute glomerulonephritis;
  • Pheochromocytoma.

Cases when the hypertensive crisis develops in completely healthy people are not excluded and not rare. The reasons are:

  1. Stressful situations, nervous shocks.
  2. Excessive alcohol consumption.
  3. Mental and physical overload.
  4. Hormonal imbalance in women during menopause or menstruation.
  5. Meteorological factors – changes in weather and climate.
  6. Acceptance of certain medications.

Complications, even if the patient is urgently treated on time, can lead to the most sad consequences. According to statistics, more than 40% of patients who were diagnosed with complicated crisis died in the next three years from strokes or acute renal failure.

Hypertensive crisis – >5 - Complications of a hypertensive crisisHypertensive crisis can be classified according to numerous criteria. Hyperkinetic, hypokinetic, and eukinetic crises emit a mechanism for increasing blood pressure. The easiest of them is considered hyperkinetic, giving complications in very rare cases.

But the most appropriate and widespread classification is considered to be the separation according to the degree of damage to target organs. There are complicated and uncomplicated hypertensive crisis. Depending on what kind of organs and how affected, further treatment of the patient is determined. Pressure reduction is not a priority.

The most common complications of a hypertensive crisis are as follows:

  • Cerebral infarction – occurs in 24% of cases of complicated hypertensive crisis;
  • Pulmonary edema – 22%;
  • Hypertensive encephalopathy or cerebral edema – 17%;
  • Acute left ventricular failure – 14%;
  • Myocardial infarction and unstable angina pectoris – 12%;
  • Eclampsia – 4,6%;
  • Stratification of an aortic aneurysm – up to 2%.

Almost all patients with complicated hypertensive crisis need emergency medical care. Parenteral treatment is carried out using appropriate medications; it is required to lower blood pressure by 20-25 units within an hour.

The patient must be hospitalized and already in a hospital, after stabilization of his condition and examination, further treatment is determined.

The primary role in this is played by the elimination of a developed and progressive disease, and not the reduction and maintenance of blood pressure at the same level.

Medication for hypertensive crisis

N1346753810325 - Complications of a hypertensive crisisTreatment of a hypertensive crisis in a hospital environment involves predominantly intravenous administration of drugs. Taking pills may seem more convenient. But such treatment is advisable at home with a relatively stable patient condition.

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If you want to ensure the fastest possible effect of the drug and at the same time control its intake into the body, it is better to use intravenous infusion.

If Nitroglycerin or Sodium nitroprusside is administered in this way to lower blood pressure, then as soon as the necessary indicators are achieved, the drug can be stopped immediately.

It is obvious that if the patient took the tablets orally, and the dosage was exceeded, it will be impossible to quickly stop the action of active substances. This can lead to serious complications if the patient’s condition worsens with a sharp decrease in blood pressure. Therefore, in this case, the intravenous administration of drugs is more effective and safe.

The following are the main drugs that are traditionally used to stabilize the patient after a complicated hypertensive crisis.

Sodium nitroprusside

This drug is the most common at the moment in the treatment of complicated hypertensive crisis. It has a vasodilating effect and is the drug of choice for the development of such complications:

  1. Acute hypertensive encephalopathy.
  2. Acute left ventricular failure.
  3. Postoperative hypertension.
  4. Exfoliating aorta.

With intravenous infusion, sodium nitroprusside begins to act in a few seconds. 3-5 minutes after getting into the blood, blood pressure indicators return to normal. Thus, it is possible to reduce the risk of hypotension several times by controlling the rate of administration of the drug and its amount.

With the introduction of the substance, such adverse reactions can be observed:

  • Nausea and vomiting;
  • Muscle cramps;
  • Reflex tachycardia;
  • Arterial hypotension;
  • Nephrotoxicity;
  • Methemoglobinemia.

During the administration of this drug, blood pressure monitoring should be continuously performed. Long-term treatment can provoke cyanide intoxication. If a patient begins to nausea and vomit when using sodium nitroprusside, he panics, the drug is stopped, and vitamin B12 and sodium thiosulfate are used as an antidote.

Sodium nitroprusside is not prescribed for acute cerebrovascular accident, hypothyroidism, aortic stenosis, aortic coarctation, optic nerve atrophy, glaucoma, acute liver or kidney failure.

Vitamin B12 deficiency and individual intolerance to the drug are also contraindications, which can be considered relative if there is a clear threat to the patient’s life.

Nitroglycerine

nitroglicerin lekfarm 936 - Complications of a hypertensive crisisThis drug is a peripheral vasodilator, its action is aimed at reducing the myocardial oxygen demand. It dilates the peripheral vessels, reducing their resistance, and reduces the flow of blood to the right atrium.

Treatment with nitroglycerin in acute coronary insufficiency in combination with hypertensive crisis is preferable than treatment with sodium nitroprusside – Nitroglycerin acts more intensively on coronary vessels.

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Indications for use of this drug are acute left ventricular failure and arterial hypertension after coronary artery bypass grafting. If Nitroglycerin is continuously administered (more than 24 hours), tolerance to this substance may develop. Side effects include:

  • Headache;
  • Reflex tachycardia;
  • Vomiting;
  • Arterial hypotension.

Nitroglycerin is not prescribed for patients with increased sensitivity to nitrates, with high intracranial pressure, hemorrhagic stroke, subarachnoid hemorrhage, hypothyroidism.

Beta-blockers and alpha-blockers

The group of beta-blockers include Propranolol, Metoprolol tartrate, Esmolol. They are used to lower blood pressure in hypertensive crisis, complicated by stratification of aortic aneurysm, acute myocardial ischemia, as well as in post-traumatic or postoperative hypertension.

Beta-blockers are not used for sinus node weakness syndrome, sino-atrial blockade, atrio-ventricular block, bradycardia, acute and chronic heart failure with severe course, bronchial asthma.

From the group of alpha-blockers, Phentolamine, Prazosin are mainly used. These drugs are needed if a high level of catecholamines in the blood is noted with a hypertensive crisis and emergency care is needed for a hypertensive crisis.

Side effects such as tachycardia, headaches, orthostatic hypotension are possible.

Methyldopa and Magnesium Sulfate

i 1 - Complications of a hypertensive crisisMethyldopa has a direct effect on the central mechanisms of the brain, which are responsible for regulating blood pressure. This substance suppresses sympathetic impulses to vessels and stimulates alpha-adrenergic receptors. The use of the drug causes severe drowsiness, it is not prescribed for acute myocardial infarction.

Magnesium sulfate is prescribed for such a complication of a hypertensive crisis as eclampsia and preeclampsia. It is used to prevent seizures, eliminate cerebral edema, and lower blood pressure. The drug can not be administered intravenously too quickly, otherwise you can cause a spasm of the bronchi, lungs and an attack of suffocation.

Magnesium sulfate begins to act 20 minutes after administration, the effect lasts up to 6 hours. If you need to stop the action of the substance in case of an overdose, calcium gluconate is administered intravenously as an antidote. What you need to know about hypertensive crisis will tell Elena Malysheva in the video in this article.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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