Hypertensive crisis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Hypertensive crisis
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Severe headache, shortness of breath, nosebleeds, severe anxiety
Complications	Stroke, heart attack, kidney damage, aortic dissection
Onset	Sudden
Duration	Variable
Types	N/A
Causes	Poorly controlled hypertension, medication noncompliance, pheochromocytoma, renal artery stenosis
Risks	Chronic kidney disease, diabetes mellitus, obesity, smoking, excessive alcohol consumption
Diagnosis	Blood pressure measurement, clinical evaluation
Differential diagnosis	Panic attack, anxiety disorder, pheochromocytoma
Prevention	Regular blood pressure monitoring, medication adherence, lifestyle modification
Treatment	Antihypertensive medication, hospitalization
Medication	Nitroprusside, labetalol, nicardipine
Prognosis	Variable, depends on promptness of treatment
Frequency	Common in individuals with uncontrolled hypertension
Deaths	N/A

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can damage blood vessels. The blood vessels become inflamed and may leak fluid or blood. As a result, the heart may not be able to pump blood effectively.

Types of Hypertensive Crisis

There are two types of hypertensive crises: hypertensive urgency and hypertensive emergency.

Hypertensive Urgency

In a hypertensive urgency, blood pressure is extremely high, but there is no associated organ damage. Patients may experience severe headaches, shortness of breath, or nosebleeds, but these symptoms are not life-threatening. Treatment often involves oral antihypertensive medications and close monitoring.

Hypertensive Emergency

A hypertensive emergency is a situation where high blood pressure results in damage to organs. This can include encephalopathy, myocardial infarction, pulmonary edema, or aortic dissection. Immediate hospitalization and intravenous antihypertensive medications are required to prevent further organ damage.

Causes

Hypertensive crises can be caused by a variety of factors, including:

• Chronic hypertension
• Renal artery stenosis
• Pheochromocytoma
• Pregnancy-related hypertension
• Medication noncompliance
• Drug interactions

Symptoms

Symptoms of a hypertensive crisis can vary depending on the severity and type. Common symptoms include:

• Severe headache
• Shortness of breath
• Nosebleeds
• Severe anxiety
• Chest pain
• Confusion
• Blurred vision

Diagnosis

Diagnosis of a hypertensive crisis involves measuring blood pressure and assessing for signs of organ damage. Additional tests may include:

• Electrocardiogram (ECG)
• Blood tests
• Urinalysis
• Imaging studies such as CT scan or MRI

Treatment

The treatment of a hypertensive crisis depends on whether it is a hypertensive urgency or emergency. In a hypertensive urgency, oral medications such as labetalol, captopril, or clonidine may be used. In a hypertensive emergency, intravenous medications such as nitroprusside, nicardipine, or labetalol are administered.

Prevention

Preventing a hypertensive crisis involves managing hypertension through lifestyle changes and medication adherence. Regular monitoring of blood pressure, maintaining a healthy diet, regular exercise, and avoiding tobacco and excessive alcohol can help prevent hypertensive crises.

See also

• Hypertension
• Stroke
• Heart failure
• Kidney disease