Content

• Steps
• Part 1 of 3: Symptoms of a hypertensive crisis
• Part 2 of 3: Medication
• Part 3 of 3: Controlling Your Blood Pressure
• Additional articles

You have probably heard of high blood pressure, or hypertension. However, did you know that there is malignant hypertension? Malignant hypertension, or hypertensive crisis, is a rapid increase in blood pressure that negatively and destructively affects one or more organs. This is a very serious condition that requires immediate medical attention. If you suspect that you or someone you know is developing a hypertensive crisis, you should contact the nearest medical facility as soon as possible.

Steps

Part 1 of 3: Symptoms of a hypertensive crisis

1. 1 Distinguish between benign and malignant hypertension. In benign hypertension, blood pressure can gradually decrease over weeks or months under close medical supervision. In the case of malignant hypertension, urgent intervention with intravenous drugs is needed to lower blood pressure. Otherwise, high blood pressure can damage blood vessels in the brain, eyes, kidneys, and heart. If you have malignant hypertension, your doctor will assess the symptoms and prescribe appropriate treatment.
   • The term "malignant hypertension" appeared in the 1920s, and today it is somewhat outdated. Nowadays, this condition is often called a hypertensive crisis. A hypertensive crisis is characterized by the fact that the systolic pressure rises above 180, or the diastolic pressure rises above 120.
   • For example, a third of US residents have high blood pressure, but only 1% of those suffering from hypertension are susceptible to malignant hypertension, or hypertensive crises. The rest have benign hypertension.
2. 2 Brain damage. If you have extremely high blood pressure, your doctor will check to see if you have any of the following signs of central nervous system damage:
   • Severe headache, especially upon waking. This is the most common symptom, provided there are any symptoms at all.
   • Vomiting without other symptoms of gastrointestinal upset, such as diarrhea.
   • Blurred vision.
   • Stroke.
   • Convulsions.
   • Head injury.
   • Swelling of the optic nerve head. Your doctor will dilate your pupil to look at the optic nerve head, which is usually well-defined. In a hypertensive crisis, the doctor will see a blurred disc with distorted edges.
   • Minor bleeding in the eyes. This bleeding is caused by the rupture of tiny blood vessels in the eyes due to high blood pressure.
3. 3 Damage to the heart. A hypertensive crisis is less likely to damage the heart. However, damage is possible, and it manifests itself in difficulty breathing during physical activity, as well as at rest and even when lying down. This is because fluid builds up in the lungs and the heart struggles to push blood through it. Chest pain is also possible due to the increased stress on the heart, which pumps blood under high pressure conditions. Your doctor will do an external examination looking for signs of congestive heart failure. These signs include:
   • Jugular veins protruding on a swollen neck.
   • Raising blood in the jugular veins with pressure on the liver (hepatic-jugular reflux).
   • Swelling of the feet.
   • Every third or fourth heartbeat resembles a "jump" due to the congestion of the ventricle, which is full of blood (this is also found on the electrocardiogram).
   • A chest x-ray shows signs of congestive heart failure, fluid buildup in the lungs, and an enlarged heart.
   • Chemicals secreted by the ventricles of the heart in congestive heart failure (brain natriuretic peptide and troponin). These substances are found in laboratory tests, and additional tests may be required if the doctor suspects that the damage may be due to other causes.
4. 4 Kidney damage. The doctor will order laboratory tests of the kidneys to find out how they are functioning. A hypertensive crisis often leads to changes in kidney function and neurological consequences. The doctor will notice the following symptoms:
   • Swelling of the feet.
   • A hissing sound in the area of ​​the renal arteries, indicating that blood flow is obstructed.
   • The presence of protein in the urine. Since the kidneys have to filter out protein, this indicates damage to the kidney tissue due to extremely high blood pressure.
   • The ratio of the concentration of urea nitrogen to the content of creatinine in the blood. Normally, this ratio should be 1, but with kidney damage, it increases by 1 per day. For example, if this ratio is 3, it means that the kidneys were damaged three days ago.
5. 5 Learn to distinguish between primary and secondary malignant hypertension. Primary hypertensive crisis is the development and exacerbation of benign hypertension, which suddenly leads to organ damage. In a secondary crisis, malignant hypertension is caused by other diseases. To determine the type of hypertensive crisis, the doctor will order additional tests or use imaging techniques. With a hypertensive crisis, it is necessary not only to lower blood pressure, but also to try to get rid of its cause. Secondary hypertensive crisis can be caused by the following reasons:
   • Pregnancy (for example, in the case of preeclampsia). The disease goes away after childbirth, however, even before them, the symptoms are amenable to temporary drug treatment in the event that the baby's lungs are not yet fully formed, and the mother does not have neurological symptoms. For hypertensive crisis during pregnancy, drugs such as magnesium sulfate, methyldopa, hydralazine and labetalol should be used.
   • Cocaine use or overdose. In this case, the same treatment methods are used as in the primary hypertensive crisis.
   • Alcohol withdrawal. In this case, malignant hypertension is treated with the drug Benzodiazepine.
   • Stop taking beta-blockers. Sudden cessation of beta-blockers or high blood pressure medications can cause withdrawal symptoms, in which case beta-blockers are prescribed to treat the hypertensive crisis.
   • Stop taking alpha-blockers (clonidine).
   • Renal artery stenosis, which is a narrowing of the arteries that carry blood to the kidneys. Treatment consists of surgery (called angioplasty) to widen the arteries.
   • Pheochromocytoma, or adrenal gland tumor. Treatment usually consists of removing the tumor.
   • Coarctation of the aorta is a congenital defect in which the aorta is shortened. The defect is eliminated through an operation.
   • Hypothyroidism It is treated with medication, surgery or beta-blockers.
   • Dissection (rupture) of the aorta. In this case, an operation is required within a few hours, since the situation is extremely life-threatening.

Part 2 of 3: Medication

1. 1 Talk to your doctor about medications for malignant hypertension. Since many factors must be taken into account when diagnosing a hypertensive crisis, there are no universal recommendations regarding pharmacology or medical therapy. Before starting immediate treatment, your doctor will assess your medical history and current condition.
   • The doctor must take into account the interaction between drugs (especially if it is the cause of a hypertensive crisis), the resources available in the medical institution and the level of available medical expertise.
2. 2 Get ready for treatment. The doctor will immediately try to lower the blood pressure to a safe level within one hour (usually a 10-15% reduction). Blood pressure should continue to decrease over the next 24 to 48 hours while you are under intensive care. Your doctor will then switch you from intravenous to oral medications to prepare you for discharge from the hospital.
   • In the treatment of hypertensive crisis, intravenous injections of drugs are always used. Transfer to oral drugs is carried out as follows: gradually reduce the intravenous dose and replace it with an oral drug of the same class.
3. 3 Start with labetalol. It is a beta blocker that blocks the action of epinephrine and adrenaline.Labetalol is given in case of a heart attack (myocardial infarction or angina pectoris) in a hypertensive crisis. It lowers blood pressure quickly and is easy to administer intravenously.
   • Because the lungs also have beta receptors, labetalol is less commonly used to treat patients with hypertensive crisis when it is accompanied by pulmonary edema.
4. 4 Take sodium nitroprusside to dilate your blood vessels and facilitate blood flow. Nitroprusside is a vasodilator used to dilate or open blood vessels. It allows you to very quickly lower your blood pressure. Since nitroprusside is administered using a continuous intravenous infusion pump, the dosage can be easily varied from 0.25 to 8.0 mcg / kg / min. In this case, a sensor tube is inserted into the femoral artery for constant monitoring.
   • When nitroprusside is injected, you will be constantly monitored. Due to its rapid action, this drug may cause blood pressure to drop too quickly and too quickly. Such a fall can lead to insufficient blood supply to the brain. Fortunately, the dosage of the drug is easy to adjust.
   • Another fast-acting vasodilator is fenoldopam. As a rule, it is prescribed for patients with renal insufficiency.
5. 5 You may have your blood vessels dilated with Nicardipine. This calcium antagonist blocks the calcium channels of cells in the smooth muscle of the blood vessels. As a result, the vessels dilate, which leads to a decrease in blood pressure.
   • Nicardipine makes it easy to achieve optimal blood pressure. In addition, after Nicardipine, it is easy to switch to an oral drug such as Verapamil.
6. 6 You may also be prescribed less common drugs. Depending on your condition, your doctor may use one of the following intravenous drugs:
   • Hydralazine. This drug is used to treat hypertensive crisis in pregnant women, as it is safe for the fetus.
   • Phentolamine. This remedy is used only in cases where the hypertensive crisis is caused by a tumor of the adrenal glands (pheochromocytoma).
   • Lasix. This drug is used for the supportive treatment of hypertensive crisis. It is a diuretic and promotes the elimination of excess fluid. Lasix is ​​useful in cases where a hypertensive crisis is accompanied by pulmonary edema or congestive heart failure.
   • Enalapril. This ACE inhibitor promotes vasodilation, but should not be used in renal failure.

Part 3 of 3: Controlling Your Blood Pressure

1. 1 Follow your doctor's instructions. During treatment, it is necessary to follow the doctor's prescriptions and follow his recommendations in everything. Your doctor will help you create a treatment plan that focuses on lowering blood pressure. Typically, the goal is to bring your blood pressure below the 140/90 level.
2. 2 Eat a low sodium diet. Make sure that your daily sodium intake does not exceed 2,000 milligrams. Too much sodium can lead to high blood pressure, which increases the risk of heart attack or stroke. Remember to eat fresh fruits and vegetables and refrain from processed foods, as they are often high in sodium.
   • Avoid canned foods as they are high in salt, which helps to maintain color and freshness. If you do purchase canned foods, choose foods that are low in salt or none at all.
3. 3 Exercise to improve heart function. Although your physical activity will be limited until you are discharged from the hospital, you can resume normal activity and exercise as soon as your blood pressure stabilizes.You can do aerobic (cardio), strength, and isometric exercises. This will help lower your diastolic and systolic blood pressure. Systolic pressure is measured when the heart contracts, while diastolic pressure is measured between contractions.
   • Doctors recommend that adults should exercise for a total of 2 hours 30 minutes per week. Try moderate-intensity exercise, such as walking, cycling, and swimming.
4. 4 Lose excess weight, if you have one. When you are overweight, your arteries have to work harder to supply blood to the body, which leads to increased blood pressure. Determine your body mass index (BMI) using an online calculator. A BMI above 30 corresponds to obesity. In this case, try to lose weight so that your BMI is in the 25-30 range.
   • Reduce your calorie intake and exercise regularly. This is the safest way to lose weight.
5. 5 Quit smoking. Smoking decreases the amount of oxygen entering the heart, increases blood pressure and heart rate, increases blood clotting, and damages cells in the coronary arteries and other blood vessels. If you smoke, you are more prone to high blood pressure, which can lead to a hypertensive crisis.
   • If you find it difficult to quit smoking, consult your doctor. Your doctor will recommend supportive medications or refer you to a psychologist who deals with similar problems.

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