Hypertensive crisis - symptoms and treatment. What is a hypertensive crisis: causes and possible complications Hypertensive crisis type 2 symptoms

There are two types of crises:

• Neurohumoral crisis (I type);
• Water-salt type of crisis (type II).

Therapeutic tactics for both types differ significantly, because they are based on various mechanisms their provocation. Therefore, the faster the treatment regimen is completed, the more profitable the result for the patient. Moreover, the need for rapid relief of the crisis is due to the risk of bleeding into the brain. Ischemic stroke is also possible. For this reason, you should carefully monitor the level of your blood pressure, especially the elderly, as well as patients suffering from arterial hypertension of the third stage with chronic heart failure.

With such a pathology as a hypertensive crisis, treatment should be started with simple techniques, after analyzing the dynamics of pressure. If it rises within a few hours, then the crisis will be neurohumoral. If for several days the pressure increased, which was accompanied by a gradual deterioration in well-being, then the crisis will be water-salt. There are fundamental differences between the tactics of treatment of both types, which are included in the complex of pre-medical and qualified medical care.

Treatment of type I hypertensive crisis at the pre-medical stage

The main mechanism for provoking a type 1 crisis is the activation of the sympathetic nervous system. It is characterized by a rapid rise in pressure in response to emotional stress or excessive exercise. For this reason, you should take the most specific means: these are beta-blockers, ACE inhibitors (angiotensin-converting enzyme inhibitors, ACE inhibitors).

Any beta-blockers that are available in the medicine cabinet of a person suffering from arterial hypertension are suitable for admission. Moreover, the time of onset of the effect in this case is very long, and therefore, to quickly reduce pressure, ACE inhibitors should be taken, namely, captopril under the tongue. You can also take nitroglycerin, which is allowed only with a crisis of the first type.

It is noteworthy that clonidine can also be used to quickly reduce pressure. However, it is not always in the medicine cabinet of a patient suffering from arterial hypertension, and therefore access to it is limited. At the same time, the patient's further tactics, regardless of how much the pressure has decreased, is to go to a medical hospital for an ambulance. You can also get to the emergency department with the help of relatives. The patient will then be referred to hospital treatment, designed to reduce blood pressure and reconsider the tactics of basic therapy for hypertension.

Schematic diagram of pre-medical treatment

1. Captopril under the tongue;
2. Enalapril (or lisinopril) orally;
3. Beta-blockers orally;
4. Nitroglycerin under the tongue 1 tablet without repetition (repeating is possible only if there are angina pectoris pains within 5-7 minutes from resorption of the tablet. If later the pain remains and does not stop after the second tablet, the third is applied. If the pain continues, then we should talk about a heart attack myocardium, which has developed due to an increase in the load on the heart against the background of cardiosclerosis or coronary artery disease).

Treatment of hypertensive crisis type II at the pre-medical stage

If a water-salt hypertensive crisis is suspected, first aid should include the use of ACE inhibitors, captopril, and beta-blockers. Moreover, the complex of drugs is almost identical to their spectrum used in the first type of crisis. However, in this case, they are prescribed for a different purpose: beta-blockers are used to reduce the load on the heart, and not to dilate blood vessels. Moreover, the vascular crisis already leads to their expansion, which is manifested by edema.

For this reason, by the way, it is impossible to use nitroglycerin, because it will aggravate the main symptoms. Vasodilation also occurs in the brain, which is accompanied by migraine-like pains of a pressing nature, as well as nausea and dizziness. This is the result of cerebral edema due to increased fluid permeability. By using nitroglycerin, the symptoms of nausea are aggravated, which can also lead to loss of consciousness and coma.

With such a pathology as a hypertensive crisis, the symptoms do not always accurately reflect the severity of the condition. However, regardless of whether you should always monitor the level of blood pressure. If it is higher than standard norms, then the treatment tactics prescribed by the doctor should be taken. However, if the drug regimen does not help, then a hypertensive crisis should be implied. And then the treatment should be appropriate.

Perhaps the main point in the treatment of the water-salt crisis on prehospital stage is the use of diuretics. The most successful use of saline diuretics, that is, furosemide. Taking it at a dose of 40 mg, you can achieve a persistent decrease in the volume of circulating blood, which will allow you to slightly reduce pressure.

Schematic diagram of first aid for type II vascular crisis:

1. Taking captopril under the tongue;
2. Taking enalapril (or lisinopril) by mouth;
3. Oral furosemide, intramuscular injection is also possible;
4. Taking beta-blockers orally.

Qualified treatment

With such a pathology as a vascular crisis, the symptoms indicate a certain type of disease. Moreover, before admission to the hospital, an ECG should be recorded in the emergency department or in an ambulance. Deciphering will eliminate the complications of the crisis, that is, myocardial infarction or other rhythm disturbances. Their treatment is also included in the spectrum of medical procedures.

During a hospital stay, patients with a pathology such as a hypertensive crisis are treated according to indicators of general well-being and blood pressure levels. The type of crisis also matters. With a neurohumoral crisis, the main drugs for treatment are beta-adrenergic blockers, long-acting ACE inhibitors (enalapril and lisinopril), and calcium channel blockers. Diuretics may be given as adjuvant therapy components, but they are not treatment-specific. In parallel, treatment of concomitant disorders, as well as complications, is prescribed. All this allows you to achieve a competent reduction in the level of pressure and stabilization of its indicator.

With a water-salt crisis, the main drugs for qualified therapy are diuretics. Their complex can be prescribed, for example, hypochlorothiazide + furosemide + veroshpiron. The use of these two drugs is due to the presence of edema throughout the body or only in abdominal cavity and lower limbs. Their elimination is one of the elements of therapy.

Also, patients with a water-salt crisis are prescribed treatment with beta-blockers, long-acting ACE inhibitors. Moreover, in the admission department they can also prescribe captopril under the tongue if information is received that the patient did not use any drugs before admission.

With such a pathology as a vascular crisis, treatment can take a short period of time, approximately 3-4 days in a medical hospital. Moreover, diagnostics of the state of the kidneys, heart, main arteries and cerebral vessels are also carried out. An examination by a neurologist may be prescribed, who will prescribe the appropriate treatment to prevent ischemic brain damage.

This tactic reduces the likelihood of ischemic strokes, which subsequently protects the patient from this pathology and a long period of rehabilitation. Therefore, even at the time of stabilization of pressure, patients should stay in the hospital for some time, since during this period another rapid rise can be observed, that is, a relapse of the crisis.

Classification of hypertensive crisis: types and types of 1st and 2nd order

A hypertensive crisis is a pathological condition characterized by a significant increase in blood pressure, occurring with neurovascular and humoral disorders.

The etiology of development is acute nervous or mental strain, excessive use alcoholic beverages, a sharp drop in atmospheric pressure, the abolition of antihypertensive drugs, etc.

Considering the many causes and provoking factors, the characteristics of the course and complications that cause a hypertensive crisis, its classification is carried out according to several principles - the mechanism of formation, the type of increase in blood pressure, hemodynamic disorders, the prevalence of symptoms.

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It is necessary to consider how a hypertensive crisis is classified, and what symptoms indicate its development? How is treatment carried out, what preventive measures are recommended?

Classification of hypertensive crisis according to the type of blood pressure and the nature of the violations

Types of hypertensive crisis, depending on the type of increase in blood pressure, are divided into systolic type, when there is an increase in upper blood pressure and diastolic type.

The second is characterized by an isolated increase in blood pressure, while the upper pressure remains within the normal range or increases slightly. The third type is a sharp jump in both indicators - a systolic-diastolic view.

Depending on what hemodynamic disturbances are observed, an attack in a hypertensive patient can be hypokinetic and hyperkinetic.

In the first variant, the syndrome increases gradually, the course is characterized by severe symptoms. As a rule, it develops in patients with arterial hypertension of the second or third stage.

Hyperkinetic syndrome begins abruptly, accompanied by a significant increase in systolic blood pressure, tachycardia.

Clinical picture

What doctors say about hypertension

I have been treating hypertension for many years. According to statistics, in 89% of cases, hypertension ends with a heart attack or stroke and the death of a person. Approximately two-thirds of patients now die within the first 5 years of disease progression.

The next fact is that it is possible and necessary to bring down the pressure, but this does not cure the disease itself. The only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension and is also used by cardiologists in their work is Giperium. The drug acts on the cause of the disease, making it possible to completely get rid of hypertension.

This type is typical for the early stages of hypertension.

Types depending on the mechanism of formation

Types of hypertensive crisis, depending on the mechanism of formation of an attack, are divided into cerebral and sympathetic-adrenal.

The sympathetic-adrenal or hypertensive crisis of the 1st type occurs against the background of a significant increase in systolic parameters, the heart rate increases, and the values ​​of glucose in the patient's body increase.

The patient feels a general malaise, the skin acquires a special pallor, trembling of the body, tremor of the extremities is detected. This type is almost impossible to predict, it always starts abruptly and sharply.

The duration of the attack is relatively short - from a few minutes to a couple of hours. Patients complain of the following symptoms:

• Headache.
• An attack of nausea (vomiting is rare).
• Violation of visual perception.
• Rapid heartbeat.
• Pain in the sternum of a stabbing character.
• Severe anxiety, panic, causeless fear.

At the end of a hypertensive attack, the patient may have profuse stools or urination. The study of urine, carried out during this period, reveals the protein components in it and single erythrocytes.

Such changes in the body in the vast majority of clinical pictures do not appear to be a disease. of cardio-vascular system, but by the transformation of venous tone. A blood test shows a high concentration of adrenaline, while norepinephrine is normal or reduced.

An attack of a cerebral nature begins gradually. Such types of pathological conditions occur for a long period of time, are characterized by particular severity. They can last up to five days, sometimes longer.

Hypertensive crisis of the 2nd type is characterized by the following clinical manifestations:

1. strong headache.
2. Drowsiness.
3. General malaise.
4. Weakness.
5. Feeling of general disorientation.
6. Attacks of nausea leading to vomiting.
7. Decreased heart rate (sometimes).

With excessive expression clinical picture loss of consciousness with subsequent complications is not excluded.

Almost all patients note pain in the region of the heart, which is accompanied by increasing shortness of breath, asthma of a cardiac nature is not excluded. Approximately 50% of the pictures in the urine revealed a large amount of proteins and red blood cells.

Electrocardiography revealed severe left ventricular failure.

Types according to the prevalence of syndromes

If a patient has a hypertensive crisis, its types can be classified depending on the prevalence of syndromes. During an attack of the neuro-vegetative order, patients suffer from increased anxiety, irritability and agitation, anxiety.

Fear for one's condition and one's life leads to a rapid heartbeat, hyperemia of the skin, mainly of the face, the skin becomes moist, a strong tremor of the hands is detected, and the temperature regime of the body slightly increases. With this syndrome, the patient has a significant increase in the upper pressure.

With the water-salt type, patients, on the contrary, are excessively constrained. There is severe lethargy and depression. Often there is a violation of orientation in space and time, the face swells and becomes pale. In hypertensive patients, systolic and diastolic pressures increase. Harbingers of a pathological condition are the following symptoms:

• Frequent and profuse urination, an increase in the specific gravity of urine per day.
• Swelling of the face and limbs.
• Muscle weakness.
• Discomfort in the region of the heart.
• Violation of the rhythm of the heart.

In type 1 and 2 hypertensive attacks, patients may have a violation of susceptibility and motor activity lower extremities, face and language.

With the convulsive type, patients lose consciousness, a convulsive state is observed. If objectively, this type is relatively rare, it appears as a complication of severe arterial hypertension. Swelling of the brain is not excluded.

When the attack ends, the patient may still be unconscious for some time, and when he comes into it, he remains disoriented in space for a long time.

Improvement general condition often replaced by complications such as stroke and heart attack, coma and subsequent death are not excluded.

Relief of a hypertensive crisis

It is necessary to reduce blood pressure values ​​gradually in order to neutralize the likely negative impact on the functionality of the kidneys and brain. It should be noted that lowering the pressure without pills will not work.

To help the patient against the background of this condition, first of all, it is necessary to call a medical team, then direct all actions to alleviate the symptoms, prevent complications, the likelihood of which is extremely high.

In the uncomplicated form, you can take Nifedipine, an oral drug that provides a quick but short-term decrease in blood pressure. Dosage varies from 5 to 10 mg under the tongue. In case of insufficiency therapeutic effect within half an hour, repeat the reception. The total maximum dose should not exceed 30 mg.

Captopril is a drug that provides a long-term blockade of calcium channels, which allows you to stop an acute condition. The therapeutic effect is observed 10 minutes after application, the result lasts for 5 hours.

Depending on the characteristics of the crisis, the following groups of agents may be recommended:

1. Beta blockers.
2. Medicines with antihypertensive effect.
3. calcium antagonists.
4. ACE inhibitors.
5. Diuretics.

Treatment should be started at the first symptoms of a crisis. Ignoring the situation leads to a heart attack, angina pectoris, cerebral hemorrhage, kidney failure, disruption of the central nervous system.

Prevention

Prevention of a pathological condition consists in the exclusion of activities that are based on nervous tension. It is recommended to stop smoking, taking alcohol, as they provoke spasm of blood vessels.

As a rule, doctors recommend gymnastics for hypertension, which, when performed regularly, helps to lower blood pressure (both systolic and diastolic), improves overall well-being, and normalizes blood circulation.

You should independently monitor blood pressure indicators, record the results in a diary, which allows you to track the dynamics of jumps. The patient must be taken medicines recommended by the doctor.

It is worth emphasizing that medications are aimed at lowering blood pressure and stabilizing it at the required level. Even after achieving the desired result, it is not necessary to refuse to take medications, only a doctor can withdraw the appointment.

The dominant role in the prevention of hypertensive attack has a diet. With vascular ailments, he showed table number 10. The diet implies the exclusion of all foods that increase vascular tone and irritate the central nervous system.

Excluded from the menu:

• Fried and spicy food, coffee, tea, spirits.
• Restriction of table salt to 5 grams per day, and it is better to completely abandon the crystalline powder.
• Obesity reduces the daily calorie intake.
• Fatty meats and fish are excluded.

A hypertensive crisis is a complication of arterial hypertension that is almost impossible to predict. Despite the well-established algorithm for stopping an attack, it is better not to bring it up through the daily control of hypertension.

Drawing conclusions

Heart attacks and strokes are the cause of almost 70% of all deaths in the world. Seven out of ten people die due to blockage of the arteries of the heart or brain.

Especially terrible is the fact that the mass of people do not suspect at all that they have hypertension. And they miss the opportunity to fix something, simply dooming themselves to death.

• Headache
• Increased heart rate
• Black dots before the eyes (flies)
• Apathy, irritability, drowsiness
• blurred vision
• sweating
• Chronic fatigue
• swelling of the face
• Numbness and chills in fingers
• Pressure surges

Even one of these symptoms should make you think. And if there are two of them, then do not hesitate - you have hypertension.

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1. Type 2 hypertensive crisis (complicated) in hypertension: diagnosis, treatment.

Significant, sudden increase in blood pressure with neurovascular and humoral disorders. The occurrence of hypertensive crises is facilitated by acute neuropsychic overstrain, excessive alcohol consumption, sudden changes in the weather, the abolition of antihypertensive drugs, etc.

A hypertensive crisis is manifested by headache, dizziness, sometimes the appearance of a "fog" before the eyes, nausea and vomiting. A characteristic feature of the hypertensive crisis is the feeling of heaviness behind the sternum. A hypertensive crisis can occur suddenly against the background of good health.

With a large variability in the clinical manifestations of a hypertensive crisis, for adequate emergency care, depending on the characteristics of central hemodynamics, hyperkinetic and hypokinetic crises are isolated. In a hyperkinetic crisis, an increase in blood pressure is mainly due to excessive work of the heart (increased cardiac index). In a hypokinetic crisis, the main mechanism for increasing blood pressure is increased peripheral resistance. emergency assistance the doctor is unable to determine the type of central hemodynamics during a hypertensive crisis, and therefore the classification of crises is based on clinical manifestations.

Allocate hypertensive crisis of I and II types and complicated

Type II hypertensive crisis (hypokinetic) more often develops in patients with stage 11B-III hypertension with insufficient effective treatment or disruption of lifestyle. Crisis symptoms develop more slowly, but very intensively. Within a few hours, the headache increases (sharpest). Nausea, vomiting, lethargy appear, vision and hearing deteriorate. The pulse is tense, but not rapid; Blood pressure is sharply increased, mainly diastolic (domm Hg). On the ECG - a moderate widening of the QRS complex, a decrease in the ST segment, a biphasic or negative T wave in the left chest leads. In the urine, especially at the end of the crisis, a significant amount of protein, cylinders and erythrocytes.

Complicated hypertopic crisis may occur in the cerebral, coronary or asthmatic variant. In contrast to an uncomplicated hypertensive crisis, in complicated variants of a crisis, against the background of high blood pressure M0iyr, acute coronary insufficiency (cardiac asthma, pulmonary edema), acute left ventricular failure (cardiac asthma, pulmonary edema), acute cerebrovascular accident (hypertensive encephalopathy, transient cerebrovascular accident) develop , hemorrhagic or ischemic stroke).

A good therapeutic effect in type II hypertensive crisis is given by clonidine (gemiton, catapressan). With intravenous slow administration of 0.05-0.15 mg of clonidine in a 5-20% glucose solution, a pronounced hypotensive effect occurs. After the introduction of clonidine, the patient must comply with bed rest for 1-2 hours.

Rapid hypotensive effect t gives intravenous jet injection of 20 ml of hyperstat (diaxysone). The decrease in blood pressure occurs within the first 8 minutes and lasts for several hours. With great care, diazoxide should be used in patients with impaired cerebral and coronary circulation. After the introduction of hyperstat (diazoxide), a collaptoid state is possible, which is stopped by intravenous administration of 0.5 ml of a 1% mezaton solution. Effectively reduces blood pressure in hypertensive crises by taking 0.01 gcorinfar (nifedipine) under the tongue.

For relief of complicated type II crisis with a moderate increase in blood pressure, antipsychotics can be used. With slow intravenous administration of 1-3 ml of a 0.25% solution (2.5-7.5 mg) of droperidol in 20 ml of a 5-20% glucose solution, the state of health quickly improves and blood pressure decreases. The favorable effect begins to appear after 2-4 minutes and becomes more pronounced in 1 minute. However, the effect is short-lived - up to 1 hour. To enhance the hypotensive effect of droperidol, it is advisable to prescribe diuretics orally in combination with antihypertensive drugs.

In hypertensive crisis with a significant increase in blood pressure and signs of acute left ventricular failure appropriate intravenous administration of ganglioblockers and diuretics. A quick effect occurs with intravenous drip injection of 1-2 ml of a 5% solution of pentamin vml of 5-20% glucose solution or isotonic sodium chloride solution at a rate of drops per minute. The hypotensive effect occurs within a minute and lasts for an hour. One should strive to immediately reduce systolic blood pressure in the first minutes by 25-30% compared with the initial level. In the future, blood pressure should be measured every 5-10 minutes for an hour while the patient is in horizontal position. If drip administration is not possible, pentamine can be administered intravenously slowly (within 7-10 minutes) - 0.5-1 ml of a 5% solution in 20 ml of a 5-20% glucose solution with continuous monitoring of blood pressure.

With the jet administration of pentamine, especially in the elderly, a collaptoid state may develop. In case of its occurrence, it is necessary to inject 0.5 ml of a 1% solution of mezaton intravenously. With general excitation, it is possible to combine the administration of ganglioblockers with droperidol, which eliminates excitation and enhances the hypotensive effect of ganglioblockers.

Hypertensive crisis complicated by acute coronary insufficiency is stopped while using painkillers and nitrates. Depending on the intensity of pain, various drugs are administered intravenously: analgesics (2-4 ml of a 50% solution of analgin), narcotic drugs (promedol, omnopon 1-2 ml or morphine 1 ml with 0.3-0.5 ml 0.1 % atropine solution, diluted in 20 ml of isotonic sodium chloride solution). The method of choice for stopping a hypertensive crisis of this type is neuroleptanalgesia (1-2 ml of a 0.005% solution of fentanyl and 1-2 ml of a 0.25% solution of droperidol in 20 ml of a 5-40% glucose solution are injected into a vein). The effect occurs 2-3 minutes after administration. At the same time, nitrates are used in the form of ointment applications or sustak, nitrong, nitrosorbid.

hemocytopenia is a hematopoietic disorder. ANEMIA (anemia) - a decrease in the total amount of hemoglobin in the blood, which, with the exception of acute blood loss, is characterized by a decrease in the level of hemoglobin per unit volume of blood.

Classification: According to the mechanism of development: anemia due to blood loss (posthemorrhagic); anemia due to increased blood destruction (hemolytic); anemia due to impaired blood formation, which in turn are divided into: iron deficiency; porphyrin-deficient; B12 folic deficiency; hypo-, aplastic and metaplastic. By type of hematopoiesis: normoblastic; megaloblastic. According to the color index, the most important differential diagnostic criterion: normochromic, when the color index is 0.82-1.05; hypochromic if the color index is less than 0.82; hyperchromic, when the color index is above 1.05.

Anemia posthemorrhagic acute- anemia due to acute blood loss for a short period of time. Clinical picture: palpitations, shortness of breath, drop in arterial and venous pressure, pallor of the skin and mucous membranes.

Iron deficiency anemia associated with iron deficiency in the body. Clinical picture: lethargy, increased fatigue even before the development of severe anemia, constipation, headache, taste perversion, brittleness, curvature and transverse striation of nails, hair loss, imperative urge to urinate, urinary incontinence, pallor of the skin and mucous membranes, palpitations , shortness of breath on exertion. The color index is usually low (sometimes below 0.5); severe hypochromia of erythrocytes, ichanisocytes, poikilocytosis; ESR is usually slightly increased. The most important indicator of the disease is a decrease in the level of serum iron (normammol / l for men; mmol / l for women).

hereditary anemia associated with a violation of the synthesis of porphyrins (sideroahrestic anemia), are characterized by hypochromia of erythrocytes, an increase in the level of serum iron, iron deposition with a picture of hemosiderosis of organs. The pathogenesis of the most common form is associated with a violation of the synthesis of protoporphyrin, which leads to a violation of the binding of iron and its accumulation in the body with a sharply disturbed formation of hemoglobin. Clinical picture: moderate anemia with a sharply reduced color index. There are no trophic disturbances. Complaints of weakness, fatigue. Men are more often affected. The disease is inherited in a recessive manner, inheritance is linked to the X chromosome. At the onset of the disease, a slight increase in the spleen is sometimes noted, later, due to increased deposition of iron in the organs, hemosiderosis of the liver develops (the liver enlarges and becomes dense), the pancreas (a picture appears diabetes). The accumulation of iron in the heart muscle leads to severe circulatory failure, testicular hemosiderosis is accompanied by the development of eunuchoidism. Sometimes the skin takes on a gray tint. Blood picture: pronounced hypochromia of erythrocytes (color index 0.4-0.6), the level of hemoglobin is reduced, the number of erythrocytes is changed to a lesser extent, the level of serum iron is increased. Morphologically, anisocytosis, poikilocytosis, and sometimes a small number of target-shaped forms are noted. The content of reticulocytes is usually normal. Other blood counts are normal.

Megaloblastic anemias- a group of anemias, a common symptom of which is the detection in the bone marrow of peculiar erythrokaryocytes with structural nuclei that retain these features in the later stages of differentiation (the result of impaired DNA and RNA synthesis in cells called megaloblasts), in most cases megaloblastic anemia is characterized by a color index above one. Since the synthesis of nucleic acids concerns all bone marrow cells, frequent signs of the disease are a decrease in the number of platelets, leukocytes, and an increase in the number of segments in granulocytes.

Anemia associated with vitamin B12 deficiency regardless of the causes of this deficiency, they are characterized by the appearance of megaloblasts in the bone marrow, intramedullary destruction of erythrocytes, hyperchromic macrocytic anemia, thrombocytopenia and neutropenia, atrophic changes in the mucous membrane gastrointestinal tract and changes in the nervous system in the form of funicular myelosis.

Hemolytic anemia are associated with increased destruction of erythrocytes, an increase in the blood content of erythrocyte decay products - bilirubin or free hemoglobin, or the appearance of hemosiderin in the urine. An important sign is a significant increase in the percentage of "newborn" erythrocytes - reticulocytes in the blood due to an increase in the production of red blood cells. Clinical manifestations of the disease are jaundice, an enlarged spleen, a tendency to form gallstones.

hypertensive crises.

According to clinical features, hypertensive crises of the first and second types (order) are conditionally distinguished.

Crises of the first type differ significantly from the severe symptom complex, which is usually the crises of the second type.

Crises of the first type are often based on a psycho-emotional factor, therefore they develop without visible organic prerequisites in stages I or II of hypertension and last from several minutes to 2-3 hours. The crisis begins suddenly, usually against the background of general well-being of patients: a sharp headache appears , often pulsating in nature, flickering "flies", a grid, a veil before the eyes, double vision, sometimes patients may temporarily lose their sight.

They are usually agitated, irritable, often extremely anxious, have a feeling of heat and dryness in the mouth, coldness of the extremities, and trembling throughout the body. Complaints of palpitations are also characteristic, stabbing pains in the region of the heart, a feeling of lack of air.

Hyperemia of the skin of the face, neck and hands is observed, which in many cases is replaced by pallor, followed by the appearance, especially in the chest area, of red spots, separate areas of hyperesthesia and less often hypoesthesia of the skin, sweating. The body temperature rises slightly (usually no more than 1 degree).

The pulse quickens, becomes more intense, the volume of heart sounds increases. When measuring blood pressure, a sharp increase in systolic pressure is determined, more often by 80–100 mm and, to a much lesser extent, diastolic, which also affects the increase in pulse pressure.

There is a marked increase in cardiac output and blood flow velocity, an increase in venous pressure, some hyperglycemia, and sometimes slight proteinuria. By the end of the crisis, polyuria (copious urine output) and profuse sweating are often observed.

Crises of the second type are observed in patients with hypertension stage III and less often stage IIB. Unlike crises of the first type, they develop slowly, lasting from several hours to 4-5, and sometimes more days, being severe manifestations of an exacerbation of the disease against the background of an already existing severe symptom complex and a high initial level of blood pressure.

The skin is cold and dry, in places there is an asymmetry in skin temperature. There are signs of cerebral disorders in the form of severe headaches, heaviness in the head, ringing in the ears, dizziness, nausea, and often vomiting, lethargy, stupor, paresthesia and, in places, hypesthesia. Sometimes there are pronounced manifestations of dynamic focal disorders of cerebral circulation up to the development of transient aphasia, amnesia, paresis. Often, severe complications develop in the form of a stroke.

Blood pressure gradually rises and reaches a high level, especially diastolic, and therefore the pulse pressure remains approximately at the initial level. The pulse rate in most cases does not change, sometimes there is bradycardia and even less often tachycardia.

Quite often, left ventricular failure develops with the appearance of signs of stagnation in the pulmonary circulation, cardiac asthma, and sometimes severe pulmonary edema. Heart failure is accompanied by a slowdown in blood flow and an increase in venous pressure. In some cases, there are pains in the region of the heart of an angina pectoris character, accompanied by focal lesions of the myocardium.

First aid for hypertensive crisis, its relief.

Common causes of hypertensive crisis:

Eating a lot of salty foods;

Large amount of liquid drunk;

Long break in eating, overeating;

With the onset of symptoms of a hypertensive crisis, it is necessary to call an ambulance. A hypertensive crisis usually develops very quickly and it must be taken into account that urgent hospitalization of the patient may be required. This is especially important with signs of a complicated hypertensive crisis or if the patient has experienced a hypertensive crisis for the first time.

The patient must be put to bed, giving him a comfortable semi-sitting position with the help of pillows. It is also necessary to warm the patient's legs: feet and shins by wrapping with a heating pad, a hot foot bath or mustard plasters on the shins. In a hypertensive crisis, it is necessary to provide the patient with access to fresh air.

He must immediately give an extraordinary dose of the medicine that he usually takes to lower blood pressure. But it should be borne in mind that if the treatment was carried out with drugs of prolonged (long-term) action (Enap, enalapril, etc.), the action of which occurs within hours, then it is necessary to take a fast-acting drug.

For example, containing papaverine hydrochloride (papaverine, papazol, andipal). The relief of a hypertensive crisis involves a decrease in pressure within 1 hour Nmm Hg. Art. compared to the original. It is important to give a diuretic, but you must first know which drug is allowed, because. with some concomitant diseases, some drugs are contraindicated. For example, with type 2 diabetes mellitus and its treatment with metformin, it is forbidden to use the common furosemide.

IMPORTANT! To stop hypertensive crises, it is necessary to discuss actions with the doctor immediately - when making a diagnosis of HYPERTENSION. If you do not have such knowledge, then you need to consult a doctor in the near future, before the onset of a hypertensive crisis. because may need an individual approach depending on the accompanying chronic diseases, which limit the list of drugs taken in hypertensive crises.

What is a hypertensive crisis: causes and possible complications

What is a hypertensive crisis? This term is used in the event that a person has a condition in which the systolic pressure in the arteries exceeds the value of 220 mm Hg, and the diastolic pressure exceeds the value of 120 mm Hg and is accompanied by neurological disorders and damage internal organs.

The incidence of this pathological condition varies and is approximately 1% of all people suffering from arterial hypertension. The duration of the crisis reaches a day or more. In some types, it lasts only a few hours.

Classification and types of hypertensive crises

According to the modern classification of hypertensive crises, several types of crisis can be distinguished, namely:

• Complicated and uncomplicated hypertensive crises.
• Type I crisis.
• Type II crisis.

Uncomplicated crisis, in turn, can be divided into the following groups:

• Eukinetic. It is manifested by the absence of dynamics of cardiac output, and a moderate increase in the total peripheral resistance.
• Hyperkinetic. It is manifested by a significant increase in cardiac output and the absence of changes in peripheral resistance.
• Hypokinetic. Differs in decrease in emission and strengthening of peripheral resistance.

Complicated or, as it is otherwise called, severe hypertensive crisis, is manifested not only by a rapid jump in blood pressure numbers, but also by strong cardiac manifestations:

• Stagnation in the pulmonary circulation.
• Violation of the coronary blood flow.
• cardiac asthma.

In addition, a complicated hypertensive crisis may be accompanied by acute cerebral circulatory failure (ACV), strokes, and in some cases even coma.

A direct effect on the structures of the brain can lead to the fact that the work of the cranial nerves will begin to be disrupted, namely, temporary blindness, deafness, and the development of aphasia. Also, against the background of a violation of the permeability of cerebral vessels and the development of its edema, the occurrence of convulsive state with loss of consciousness.

Separately, hypertensive cerebral crisis (cerebral) should be highlighted. Its occurrence is explained by the rapid increase in pressure in the bloodstream and causes disruption of the vascular bed in the brain. The following types of hypertensive crises of the cerebral variant are distinguished:

The angiohypotonic type is manifested in cases where there is a decrease in vascular tone. This leads to congestion in the veins, which, as a result, increases intracranial pressure. The manifestation of the ischemic type is associated with an insufficient supply of oxygen to the brain tissues, resulting from a spasm of the cerebral arteries. In the event that a complex type of cerebral crisis occurs, one should speak of both mechanisms.

Also, some experts distinguish neurovegetative, water-salt and convulsive forms of hypertensive crisis. The neurovegetative form is characterized by the following changes:

• Abrupt start.
• Thirst.
• Redness of the skin.
• Nausea and headache.
• Flashing "flies" before the eyes.
• Change in heart rate according to the type of tachycardia.

The water-salt form is characterized by the following manifestations:

• Not an acute start.
• Lethargy.
• Pronounced edematous syndrome.
• Vomit.
• The appearance of paresthesia.

The convulsive variant is characterized by strong psychomotor agitation. It is also possible violations of the central nervous system, in particular loss of consciousness and impaired function of the visual analyzer. Vomiting and nausea in hypertensive crises of the convulsive type are also quite common.

Hypertensive crisis type 1 manifests itself extremely quickly. And it starts with a severe headache. The patient complains of fog in the eyes, dizziness, general weakness, fever. There may be a heartbeat. If we talk about pressure, then it is systolic that rises.

ECG shows depression segment S-T. In the analysis of urine, proteinuria is possible and rarely cylindria. Stopping this option is not difficult, and it lasts several hours.

A hypertensive crisis of type 2 takes a much longer period of time than type 1. It is impossible to say exactly how long it will last. With improper therapy, its duration can be several days. Pain syndrome it is much more pronounced and it is possible to attach symptoms of damage to the cranial nerves to it.

On the ECG, S-T segment depression and a prolongation of the QRS complex are possible. In the urine, not only proteins, but also erythrocytes may appear.

Causes of hypertensive crisis and risk factors

A hypertensive crisis most often develops against a background of strong psycho-emotional stress. In addition, the following factors can become the causes of the development of a hypertensive crisis:

• Change of weather conditions.
• The use of alcoholic beverages.
• Diet violation.
• Improper intake of drugs that lower blood pressure. It is extremely important how much the drug was taken. If the patient has been taking it for a long time, you should not stop taking it suddenly. This can lead to complications.
• Frequent sleep deprivation.
• Excessive physical activity.
• Exacerbation of concomitant chronic pathologies (Hypertension of the 2nd degree, diabetes mellitus).

It should also be noted that hypertensive crises can be secondary manifestations in some pathologies. Thus, the first manifestations of a hypertensive crisis may occur during the manifestation of diabetes mellitus, but only when kidney damage has already begun. The risk of a rapid increase in systolic and diastolic pressure occurs with pheochromocytoma and some connective tissue diseases.

Sometimes this condition can be confused with preeclampsia in pregnancy. But this is wrong. So, the possibility of developing a crisis occurs at any stage of pregnancy. Preeclampsia, in turn, develops in the middle of pregnancy or directly during childbirth.

It is important to understand that most often hypertensive crises are a manifestation of a disease such as arterial hypertension of the 2nd degree, moreover, even when it is secondary. This is especially true in cases where hypertension is complicated by atherosclerotic changes in blood vessels.

Irregular treatment of hypertension leads to the fact that the crisis can develop repeatedly and lead to a large number of complications.

How to identify and diagnose

To prevent this condition from being taken by surprise, it is necessary to know its main manifestations, namely:

1. Rapid increase in pressure.
2. Pain syndrome localized in the occipital region
3. Complaints about "flies" before the eyes.
4. Confusion of gait.
5. Dizziness.
6. Lack of air.
7. Feeling of nausea.
8. Vomit.
9. Palpitation.

It is extremely important to understand that when you are close to a person who complains of one or more signs, you need to seek medical help as soon as possible. The sooner the ambulance arrives, the sooner necessary treatment and, consequently, the lower the risk of possible complications. Such a disease as a hypertensive crisis requires diagnosis not only accurate, but also timely.

Hypertensive crisis: classification and signs

One of the dangerous and, unfortunately, common complications of hypertension is a hypertensive crisis. This condition is accompanied by a rapid increase in blood pressure and can threaten the health and life of the patient. According to statistics, every third hypertensive crisis in people with grade 3 hypertension ends in death. To the question of what is the danger of a hypertensive crisis, the classification of possible complications provides comprehensive information. Usually, doctors use two types of classification - according to the type of crisis and the presence of complications.

Types of crises (according to Ratner)

Most often, when making a diagnosis, the types of hypertensive crises according to Ratner are taken into account. This classification is divided into:

• hypertensive crisis type 1;
• hypertensive crisis type 2;
• complicated crisis.

The first type of crisis is characterized by the absence of complications and risks to life. With timely first aid, this condition is successfully stopped. Usually, people with grade 1 and 2 hypertension experience such a type 1 crisis.

The second type of hypertensive crisis is dangerous with the risk of damage to target organs. This condition requires urgent first aid. At home, it is often not possible to normalize the pressure, so you need to call an ambulance.

A complicated crisis according to Ratner threatens not only the health, but also the life of the patient. Among possible consequences- pulmonary edema, loss of vision, stroke or heart attack. This condition requires immediate hospitalization.

In most cases, only calling an ambulance gives a chance to avoid the worst consequences.

Among modern doctors, the Ratner classification of hypertensive types is most often used.

Type 1 crisis

Hypertensive crisis types 1 and 2 can be distinguished independently by specific symptoms. Characteristic features of this type of crisis:

• rapid increase in symptoms;
• an increase in predominantly upper pressure while maintaining the lower one within the normal range;
• headache;
• visual disturbances (mice, veil before the eyes);
• chills;
• hot flashes;
• dyspnea;
• tachycardia.

Symptoms of a crisis increase in a matter of minutes, but this state does not last long, the pressure remains high for several hours. At the same time, there is a rapid increase in upper pressure - over 180 mm Hg, and lower pressure remains within the normal range or slightly exceeds it (usually the value is mm Hg).

Hypertensive crisis or hypertension of the first type is quickly stopped at home. Its causes most often lie in the psycho-emotional state of the patient. The crisis develops against the background of stress, emotional overstrain, physical activity. The impetus for the development of a crisis may be the intake of alcohol, caffeine or the use of large amounts of salt.

Such crises do not cause dangerous complications and do not affect the functioning of internal organs. The crisis of the first type is typical for patients with hypertension of 1 and 2 degrees. Most often occurs in young people.

Type 1 hypertensive crisis is considered relatively harmless and is more common at a young age.

Crisis type 2

This type of crisis is caused by cardiac causes and is a direct consequence of the long course of hypertension. Only those patients who live for a long time with high blood pressure, characteristic of grade 3 hypertension, face a crisis of the second type.

Specific symptoms of such a crisis:

• slowly rising blood pressure;
• angina;
• dyspnea;
• panic attack;
• change in heart rate;
• disorientation in space;
• impaired coordination of movements;
• headache and dizziness;
• hot flashes;
• tremor of the fingers.

Arterial pressure reaches critical values. At the same time, the lower indicator often increases many times, which indicates a high risk of disruption of the target organs. In type 1 crisis, pulse pressure is usually higher than normal, that is, the difference between the upper and lower values ​​is more than 50 mm Hg. In a crisis of the second type, this value is often less than 30 mm Hg, which is dangerous with the risk of developing myocardial infarction.

The second type of crisis is faced by older patients who have been living with hypertension for many years. With such a crisis, the risk of complications is very high. According to statistics, every third type 2 crisis for a patient ends in death.

Complications in a crisis

There are several more types of crises according to the presence and nature of complications. Symptoms completely repeat the hypertensive crisis of types 1 and 2. In such hypertensive crises, the classification describes the likelihood of complications and methods of treatment.

It is the presence of complications in hypertension that determines the risks of this disease. Hypertension worsens the patient's quality of life and reduces performance due to the risks of developing crises, which can lead to disruption of the performance of the most important organs.

According to the presence of complications, complicated and uncomplicated crises are distinguished.

Uncomplicated crisis

Type 1 crisis and uncomplicated crisis are the same thing. With the development of this condition, there is a rapid increase in blood pressure, but there is no immediate risk to the patient's life. Due to the fact that the pressure rises sharply, while the diastolic indicator remains within the normal range or slightly exceeds it, the crisis is successfully stopped at home. Recovery from an uncomplicated crisis occurs fairly quickly.

An uncomplicated crisis can be recognized by the absence of chest pain and tachycardia. If the pulse rate increases with an increase in blood pressure, this is a normal physiological reaction. Moreover, high-pressure tachycardia indicates no risk to the myocardium. An increase in heart rate means that the heart is successfully coping with the provision of blood circulation even with high blood pressure.

In this hypertensive state urgent Care corresponds to the measures taken in case of type 1 hypertensive crises. The patient should calm down, take a comfortable position and take the drug for pressure. An uncomplicated hypertensive crisis resolves within a few hours.

A high pulse rate and no pain in the heart are signs of an uncomplicated crisis

Complicated crisis

Complicated hypertensive crisis is a serious danger. This condition requires immediate hospitalization of the patient.

A complicated crisis is characterized by the development of cardiac asthma and cerebrovascular accident. In especially severe cases, this condition leads to cerebral edema and the development of coma.

Possible consequences of such a crisis:

• pulmonary edema;
• hypertensive angiopathy;
• brain stroke;
• hypertensive encephalopathy;
• myocardial infarction;
• death.

In a complicated crisis, very high rates of both lower and upper pressure are observed. However, the difference between them can be very small. In this case, it is impossible to bring down high pressure on your own, in order to avoid dangerous complications. At home, treatment is not carried out, it is necessary to immediately call specialists at home.

In Russia, from 5 to 10 million calls to the ambulance occur annually medical care about the increase in pressure. But the Russian cardiac surgeon Irina Chazova claims that 67% of hypertensive patients do not even suspect that they are sick!

How can you protect yourself and overcome the disease? One of the many cured patients, Oleg Tabakov, told in his interview how to forget about hypertension forever.

Under hypertensive crisis understand all cases of sudden and significant increase in blood pressure (BP), accompanied by the appearance or aggravation of pre-existing cerebral, cardiac or general vegetative symptoms, the rapid progression of dysfunction of vital organs.

Criteria for a hypertensive crisis:

1. relatively sudden onset;

2. individually high rise in blood pressure;

3. the appearance or intensification of complaints of a cardiac, cerebral or general vegetative nature.

The most widely used in the practice of therapists is the division of crises of the first and second order.

Hypertensive crisis I order

It is characterized by a rapid onset against the background of a relatively satisfactory state of health, a pronounced neurovegetative syndrome with agitation, chills, trembling in the limbs, a feeling of anxiety, severe sweating. There is a throbbing headache, dizziness, nausea, vomiting, sometimes blurred vision. The face is hyperemic or covered with pale and red spots. Characterized by tachycardia, high SBP and low DBP, hyperkinetic type of central hemodynamics. Pain in the region of the heart, palpitations, a feeling of lack of air are clearly expressed. Often there is an increase in urination, after the relief of the crisis, a large amount of light urine is released. The crisis is short-term, usually no more than 2-4 hours. Complications, as a rule, are not present.

Hypertensive crisis II order

It develops gradually, lasts longer (from 6 hours to 10 days).

There are a number of syndromes:

Water-salt or edematous syndrome. It is caused by a violation of the renin-angiotensin-aldosterone system. Lethargy, drowsiness, depression of patients, sometimes disorientation in time and space is noted. The appearance of patients is characteristic: a pale puffy face, swollen eyelids, swollen fingers. Common symptoms: severe and growing headache, nausea and vomiting. May be transient focal symptoms: aphasia, amnesia, paresthesia, diplopia, the appearance of "flies", "mesh" before the eyes, blurred vision, hearing. There is a high DBP (130-160 mm Hg), low pulse pressure, hypokinetic type of central hemodynamics. The heart sounds are muffled, the accent of the II tone is over the aorta. On ECG signs systolic overload: ST segment depression, 2-phase or negative T wave in lead V5–6, QRS widening.

epileptiform syndrome. Caused by cerebral edema. Usually occurs during a crisis in patients with a persistent increase in blood pressure. Severe headache, nausea, vomiting, blurred vision. SBP - more than 200-250 mm Hg, DBP - more than 120-150 mm Hg. When examining the fundus, swelling of the nipple is found optic nerve, retina, small or extensive hemorrhages. Feelings of parasthesia, disorders of consciousness quickly appear, TIA, strokes, tonic and clonic convulsions may occur. Subdural and subarachnoid hemorrhages are often detected. The prognosis is unfavorable.

cardiac syndrome. More often develops in patients with concomitant coronary artery disease. Its basis is acute coronary and left ventricular failure. Manifested by angina pectoris, progressive angina pectoris, myocardial infarction, cardiac asthma, pulmonary edema, or cardiac arrhythmias.

Complications of a hypertensive crisis

• 1. Acute coronary insufficiency (angina attack, unstable angina pectoris, MI).
• 2. Acute left ventricular failure (cardiac asthma, pulmonary edema).
• 3. Violations of the rhythm and conduction of the heart.
• 4. Dynamic disorders of cerebral circulation, ischemic strokes, subdural, subarachnoid hemorrhages, hemorrhagic strokes, cerebral edema.
• 5. Dissecting aortic aneurysm, aneurysm rupture.
• 6. Severe retinopathy, retinal detachment, retinal hemorrhages.
• 7. Acute renal failure due to fibrinoid necrosis of the renal vessels.
• 8. Bleeding nasal, pulmonary, gastrointestinal, hematuria.

Complicated hypertensive crises are characterized by acute or progressive POM, pose a direct threat to the life of the patient and require an immediate, within 1 hour, reduction in blood pressure.

Uncomplicated hypertensive crises, no signs of acute or progressive POM, pose a potential threat to the life of the patient, require a rapid, within a few hours, decrease in blood pressure.

Treatment of hypertensive crises

At drug treatment hypertensive crises, it is necessary to solve a number of problems.

1. Stopping the increase in blood pressure. In this case, it is necessary to determine the degree of urgency of starting treatment, choose the drug and the method of its administration, set the required rate of blood pressure reduction, and determine the level of acceptable blood pressure reduction.
• 2. Ensuring adequate control over the patient's condition during the period of lowering blood pressure. Required timely diagnosis the occurrence of complications or an excessive decrease in blood pressure.
• 3. Consolidation of the achieved effect. To do this, they usually prescribe the same drug that lowered blood pressure, if not possible, other antihypertensive drugs. Time is determined by the mechanism and timing of the selected drugs.
• 4. Treatment of complications and concomitant diseases.
• 5. Selection of the optimal dosage medicines for supportive care.
• 6. Carrying out preventive measures to prevent crises.

Indications for planned hospitalization patients with hypertension:

• 1. ambiguity of the diagnosis and the need for special, often invasive research methods to clarify the form of hypertension;
• 2. Difficulties in the selection of drug therapy - frequent hypertensive crises, refractory hypertension.

Indications for emergency hospitalization:

• 1. hypertensive crises that do not stop at the prehospital stage;
• 2. hypertensive crises with severe manifestations of hypertensive encephalopathy;
• 3. complications of hypertension requiring intensive care and constant medical supervision: MI, subarachnoid hemorrhage, acute visual impairment, pulmonary edema.

This clinical syndrome, characterized by a sudden increase in blood pressure and accompanied by the appearance or aggravation of cerebral, cardiac symptoms against the background of autonomic and humoral disorders. Pathology can develop at any degree arterial hypertension and with various symptomatic hypertension. A hypertensive crisis can occur as a reaction to acute cerebral ischemia in atherosclerosis of the cerebral vessels, as well as myocardial ischemia during an angina attack.

Factors provoking the development of a hypertensive crisis can be:

• psycho-emotional and physical overload;
• hormonal disorders;
• abuse of coffee, alcohol, salty foods;
• adverse weather conditions;
• sudden withdrawal of antihypertensive drugs (beta-blockers, clonidine).

Symptoms of a hypertensive crisis

The quantitative boundaries of blood pressure during a crisis may be different, so it is important to assess the severity clinical symptoms and the risk of complications. Diagnosis hypertensive crisis can be delivered if the following signs are present:

• sudden onset (minutes to hours);
• individually high level HELL;
• the presence of complaints of a cardiac or cerebral nature, a general vegetative syndrome (chills, sweating, trembling, a feeling of heat).

There are several classifications of hypertensive crises. In the CIS countries, the classification of N.A. is more often used. Ratner (1971), in which crises of the I and II orders are distinguished:

Hypertensive crisis I order characterized by a rapid onset, a pronounced neurovegetative syndrome, accompanied by agitation, chills, hand tremors, and sweating. Patients are concerned about a throbbing headache, dizziness, nausea, less often vomiting, a feeling of lack of air. This crisis is short-term, usually lasts no more than 2-4 hours, often ends with polyuria. It does not pose a direct threat to the life of the patient.

Hypertensive crisis II order develops gradually and lasts from several hours to 5-6 days. The crisis is caused by a violation of the renin-angiotensin-aldosterone system, and therefore the clinical picture is dominated by water-salt disorders. Patients are lethargic, edematous, sometimes disoriented in time and space. Of the common symptoms, there are: severe increasing headache, the appearance of nausea, vomiting. During this crisis, transient focal symptoms can be observed: aphoria, diplopia, hearing loss and visual impairment. High diastolic pressure is recorded, the heart sounds are muffled, the accent of the II tone on the aorta is heard.

Professor M.S. Kushakovsky suggested clinical classification crises, in which a crisis with a predominance of neurovegetative syndrome, a water-salt crisis and acute hypertensive encephalopathy are distinguished. Acute hypertensive encephalopathy is a reversible clinical syndrome characterized by progressive impairment of brain function as a result of a significant increase in blood pressure. Acute hypertensive encephalopathy is an extremely severe manifestation of impaired autoregulation of cerebral blood flow. Clinically, this is manifested by confusion, convulsions, and focal neurological signs.

• complicated crises - characterized by acute or progressive damage to target organs, posing a direct threat to the life of the patient and requiring an immediate, within 1 hour, reduction in blood pressure;
• uncomplicated crises - without acute or progressive damage to target organs, posing a potential threat to life and requiring a decrease in blood pressure within a few hours.

Treatment of a hypertensive crisis

The treatment of a hypertensive crisis is based on the features of the clinical and hemodynamic variant of the course. Blood pressure during a crisis, it is necessary to reduce gradually, by no more than 25% during the first 2 hours. An excessive decrease in blood pressure can cause ischemia of the brain, heart, or kidneys. All complicated crises require immediate hospitalization in specialized departments and parenteral therapy.

Antihypertensive drugs for the relief of hypertensive crises

In uncomplicated crises, treatment can be started with sublingual captopril (12.5-50 mg), catapresan (0.15-0.3 mg) or nifedipine (10-20 mg). It should be noted that the US Joint National Committee on High Blood Pressure considers it inappropriate to prescribe nifedipine during a crisis, since this increases the risk of developing cerebral or coronary ischemia. In addition, in some patients, nifedipine can cause intense headache, as well as uncontrolled hypertension. After stopping the crisis, the doctor must analyze the causes of its occurrence and outline pharmacotherapeutic measures aimed at preventing repeated crises.

There are two groups of causes leading to the development of hypertensive crises. Firstly, it is a disruption of the adaptive functions of the central nervous system as a result of psycho-emotional stress, weather changes, and hormonal imbalance. These crises occur more often at night, in the early hours of the morning, when atmospheric pressure changes. To prevent such crises, along with antihypertensive drugs (see Drugs for high blood pressure), it is advisable to prescribe drugs that improve the metabolism of nerve cells (nootropil, glutamic acid, glycine) in courses of 2-3 months, vitamins of group B.

Second possible reason- reflex reactions to sudden ischemia or hypoxia of the brain. Such crises occur in people with diseases such as osteochondrosis of the cervical spine, heart failure, severe cerebral atherosclerosis, orthostatic hypotension. The goal of pharmacotherapeutic measures in such patients is to improve the blood supply to the brain. Courses of vasoactive drugs, nootropics are prescribed, cervical osteochondrosis is treated.

1. Guide to cardiology / N.A. Manak, V.M. Alkhimovich, V.N. Gaiduk and others; Comp. and ed. ON THE. Manak. - Minsk: Belarus, 2003. - 624 p.
2. Guide to cardiology / ed. V.N. Kovalenko. - K.: MORION, 2008. - 1424 p.

Hypertensive crisis I order

Hypertensive crises

Monitoring the effectiveness of antihypertensive therapy

In order to control the effectiveness of ongoing antihypertensive therapy, short-term, medium-term and long-term criteria have been developed.

Short-term efficacy criteria (1-6 months from the start of treatment):

1) decrease in SBP and / or DBP by 10% or more or achievement of the target level of blood pressure;

2) absence of hypertensive crises;

3) maintaining or improving the quality of life;

4) impact on modifiable risk factors.

Medium-term (more than 6 months from the start of treatment):

1) achievement of target values ​​of SBP and DBP;

2) no damage to target organs or reverse dynamics of existing complications;

3) elimination of modifiable risk factors.

Long term criteria:

1) stable maintenance of blood pressure at the target level;

2) no progression of POM;

3) the absence of progression of CVS, if any.

A hypertensive crisis is understood as all cases of a sudden and significant increase in blood pressure, accompanied by the appearance or aggravation of already existing cerebral, cardiac or general vegetative symptoms, the rapid progression of dysfunction of vital organs.

Criteria for a hypertensive crisis:

Relatively sudden onset

Individually high rise in blood pressure;

The appearance or intensification of complaints of a cardiac, cerebral or general vegetative nature.

The most widely used in the practice of therapists (due to simplicity and sufficient certainty) is the division of crises of the first and second order. This classification (N.A. Ratner) is based on clinical data, there is no need to use complex and expensive equipment.

It is characterized by a rapid onset against the background of a relatively satisfactory state of health, a pronounced neurovegetative syndrome with agitation, chills, trembling in the limbs, a feeling of anxiety, severe sweating. There is a throbbing headache, dizziness, nausea, vomiting, sometimes blurred vision. The face is hyperemic or covered with pale and red spots. Characterized by tachycardia, high SBP and low DBP, hyperkinetic type of central hemodynamics. Pain in the region of the heart, palpitations, a feeling of lack of air are clearly expressed. Often there is an increase in urination, after the relief of the crisis, a large amount of light urine is released. The crisis is short-term, usually no more than 2-4 hours. Complications, as a rule, are not present.

It develops gradually, lasts longer (from 6 hours to 10 days). There are a number of syndromes:

Water-salt or edematous syndrome. It is caused by a violation of the renin-angiotensin-aldosterone system. Lethargy, drowsiness, depression of patients, sometimes disorientation in time and space is noted. The appearance of patients is characteristic: a pale puffy face, swollen eyelids, swollen fingers. Common symptoms: severe and growing headache, nausea and vomiting. There may be transient focal symptoms: aphasia, amnesia, paresthesia, diplopia, the appearance of "flies", "mesh" before the eyes, blurred vision, hearing. There is a high DBP (130-160 mm Hg), low pulse pressure, hypokinetic type of central hemodynamics. The heart sounds are muffled, the accent of the II tone is over the aorta. ECG signs of systolic overload: ST segment depression, 2-phase or negative T wave in lead V5–6, QRS widening.

epileptiform syndrome. Caused by cerebral edema. Usually occurs during a crisis in patients with a persistent increase in blood pressure. Severe headache, nausea, vomiting, blurred vision. SBP - more than 200-250 mm Hg, DBP - more than 120-150 mm Hg. When examining the fundus, swelling of the nipple of the optic nerve, retina, small or extensive hemorrhages are detected. Feelings of parasthesia, disorders of consciousness quickly appear, TIA, strokes, tonic and clonic convulsions may occur. Subdural and subarachnoid hemorrhages are often detected. The prognosis is unfavorable.

cardiac syndrome. More often develops in patients with concomitant coronary artery disease. Its basis is acute coronary and left ventricular failure. Manifested by angina pectoris, progressive angina pectoris, myocardial infarction, cardiac asthma, pulmonary edema, or cardiac arrhythmias.