What Is Acute Hypertension?

Hypertensive emergency refers to the sudden and significant increase in blood pressure (generally over 180 / 120mmHg) in some patients with primary or secondary hypertension, accompanied by progressive heart, brain, kidney and other important factors A severely life-threatening clinical syndrome with acute impairment of target organ function. Hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage (intracerebral hemorrhage and subarachnoid hemorrhage), cerebral infarction, acute heart failure, pulmonary edema, acute coronary syndrome, aortic dissection, eclampsia, etc. The so-called malignant hypertension and hypertension crisis all belong to this category.

Basic Information

English name

HypertensiveEmergencies

Visiting department

Cardiology

Common causes

Hypersympathetic tone, acute kidney damage, acute vascular disease, endocrine disease, cardiovascular receptor dysfunction

Common symptoms

Significantly increased blood pressure, signs of autonomic dysfunction, fundus changes, congestive heart failure, progressive renal insufficiency, cerebrovascular accidents, hypertensive encephalopathy

Etiology of Hypertension

Hypersympathetic tone

Under the influence of various stress factors (such as severe trauma, severe emotional changes, excessive fatigue, cold stimulation, climate change, etc.), the sympathetic nerve tension and vasoconstrictive active substances in the blood have increased greatly, which induces a sharp rise in blood pressure in the short term.

2. Acute kidney damage < br Renal hypertension is the most common in secondary hypertension: including acute and chronic glomerulonephritis, chronic pyelonephritis (when renal function is affected in the later stages), and renal artery stenosis , Kidney stones, kidney tumors, etc.

3. Acute vascular lesions

Aortic stenosis, polyarteritis, etc. Craniocerebral lesions that increase intracranial pressure can also cause secondary hypertension.

4. Endocrine diseases

Such as pheochromocytoma secretes a sharp increase in catecholamines, or thyroid disease causes abnormal release of thyroid hormone.

5. Cardiovascular receptor dysfunction

Common in sudden-stop antihypertensive drugs.

Clinical manifestations of hypertension

Sudden onset and dangerous condition. It usually manifests as severe headache with nausea and vomiting, visual disturbances and mental and neurological abnormalities.

1. Significantly increased blood pressure

The systolic blood pressure rises above 180mmHg and / or the diastolic blood pressure increases significantly, up to more than 120mmHg.

2. Signs of autonomic dysfunction

Pale complexion, irritability, sweating, palpitations, increased heart rate (> 100 beats / min), hand and foot tremor, frequent urination, etc.

3. Performance of acute damage to target organs

(1) Fundus changes blurred vision, vision loss, fundus examination showed retinal hemorrhage, exudation, and papillary edema.

(2) Congestive heart failure: chest tightness, angina pectoris, palpitations, shortness of breath, cough, and even foamy sputum.

(3) Progressive renal insufficiency: oliguria, anuria, proteinuria, increased plasma creatinine and urea nitrogen.

(4) Cerebrovascular accident Transient sensory disturbances, hemiplegia, aphasia, irritability or lethargy in severe cases.

(5) Hypertensive encephalopathy Severe headache, nausea and vomiting, some patients may develop neuropsychiatric symptoms.

Emergency diagnosis of hypertension

1. When a hypertensive emergency is suspected, a detailed medical history collection, physical examination and laboratory examination should be performed to evaluate the involvement of target organ function in order to determine whether it is a hypertensive emergency as soon as possible.

2. The blood pressure standard for diagnosing hypertension emergencies is that the blood pressure rises sharply within a short period of time (hours to days). Generally, the systolic blood pressure is> 180mmH and / or the diastolic blood pressure is> 120mmHg.

3. Blood pressure measurement should choose a mercury column sphygmomanometer or a verified electronic sphygmomanometer that meets the measurement standards, and use an appropriately sized airbag cuff. The airbag should cover at least 80% of the upper arm. Obese people or those with large arm circumferences should use large specifications. Airbag cuffs, children should use small size airbag cuffs. You should sit and rest for at least 5 minutes before measuring blood pressure. You should not smoke or drink coffee and empty the bladder for 30 minutes. The upper arm should be placed at the level of the heart when measuring.

4. A hypertensive emergency can be diagnosed with any of the following diseases on the basis of a sharp rise in blood pressure: Hypertensive encephalopathy; Acute coronary syndrome: unstable angina pectoris, myocardial infarction; acute left ventricular dysfunction acute aortic dissection; acute renal failure; acute intracranial vascular accident: hemorrhagic cerebrovascular accident, thrombotic cerebrovascular accident, subarachnoid hemorrhage; catecholamine status: pheochromocytoma crisis, The interaction of monoamine oxidase inhibitors with tyramine stops the antihypertensive drugs.

5. It should be noted that the level of blood pressure is not directly proportional to the degree of acute target organ damage. Some hypertensive emergencies are not accompanied by particularly high blood pressure values, and those with acute acute pulmonary edema, aortic dissection aneurysm, or myocardial infarction should be regarded as hypertensive emergencies even if the blood pressure is only moderately elevated.

Differential diagnosis of hypertension

Hypertension emergency should be distinguished from hypertension sub-emergency.

Hypertension subemergency refers to a significant increase in blood pressure without damage to target organs. Patients may have symptoms caused by a significant increase in blood pressure, such as headache, chest tightness, nosebleeds, and irritability. Quite a few patients have poor medication compliance or inadequate treatment.

The degree of elevated blood pressure is not the criterion for distinguishing hypertensive emergencies from sub-acute hypertension, and the only criterion for distinguishing between the two is the presence of newly occurring acute and progressive target organ damage.

Hypertension emergency treatment

Hypertensive emergencies require immediate antihypertensive treatment to prevent further damage to target organs. In the case of close monitoring of blood pressure, urine output and vital signs, short-acting intravenous antihypertensive drugs should be used depending on the clinical situation. During the process of blood pressure reduction, we should closely observe the functional status of the target organs, such as changes in neurological symptoms and signs, and whether chest pain is exacerbated. Due to the existing target organ damage, too fast or excessive hypotension can easily lead to a decrease in tissue perfusion pressure and induce ischemic events. Therefore, the initial goal of lowering blood pressure is not to make blood pressure normal, but to gradually lower blood pressure to a safe level to prevent or reduce damage to target organs such as the heart, brain, and kidneys.

In general, the goal of blood pressure control in the initial stage (within minutes to 1 hour) is to reduce the average arterial pressure by no more than 25% of the pre-treatment level. The blood pressure will be reduced to a safer level within the next 2 to 6 hours, generally about 160/100 mmHg. If such a blood pressure level can be tolerated, the clinical situation will be stable, and the blood pressure will be gradually reduced to normal levels in the next 24 to 48 hours. When lowering blood pressure, full consideration must be given to the patient's age, course of disease, degree of increased blood pressure, target organ damage, and clinical status of the merger, and specific plans must be developed from person to person. If the patient is acute coronary syndrome or hypertensive encephalopathy with no previous history of hypertension (such as caused by acute glomerulonephritis, eclampsia, etc.), the initial target blood pressure level can be appropriately reduced. If the aortic dissection aneurysm is tolerable, the target of blood pressure reduction should be as low as 100 to 110 mmHg of systolic blood pressure. It is generally necessary to use a combination of antihypertensive drugs and pay attention to a sufficient amount of -blockers. usage of. The goal of blood pressure reduction should also consider the requirements of special treatment of target organs, such as thrombolytic therapy.

See the relevant information for blood pressure control of hypertensive emergencies in different clinical situations.

Once the initial target blood pressure is reached, oral medication can be started, and intravenous medication is gradually reduced to discontinuation. After the dangerous period, non-drug treatment and drug treatment of hypertension still need to be continued. For patients whose blood pressure has fallen to a safe level in the short term, the blood pressure should be gradually reduced to normal levels within 3 to 6 months to improve the patient's prognosis.

Hypertension emergency prevention

Hypertensive emergencies are a highly dangerous cardiovascular emergency. Get prompt and effective treatment immediately. Patients with hypertension who have a sudden rise in blood pressure and are accompanied by heart, brain, kidney and other important organ dysfunction should immediately go to the hospital for treatment and receive specialist treatment to prevent serious complications. Preventive measures such as systemic antihypertensive treatment and avoiding overwork and mental stimulation can greatly reduce the occurrence of hypertensive emergencies. After the condition is stable, the patient should gradually transition to conventional antihypertensive therapy and adhere to it for a long time.