What is a hypertensive crisis: causes and possible complications. Hypertensive crises Manifestation of hypertension in children

17.05.2020

A hypertensive crisis is regarded as a complicated course of arterial hypertension (AH). The main factors (causes) that lead to the development of hypertensive crises are acute and chronic stressful situations, changes in weather conditions, excessive consumption of table salt, exposure to infectious agents (influenza, acute respiratory diseases), discontinuation of antihypertensive drugs, administration of antispasmodics and diuretics in patients with pheochromocytoma. The main thing that cannot be done is to independently adjust antihypertensive therapy. This should only be done on the advice of a doctor.

Definition and classification

Hypertensive crisis (HC) is a clinical syndrome characterized by:

sudden and violent exacerbation of primary or secondary hypertension;
a sharp increase in blood pressure to individually high numbers;
subjective and objective manifestations of cerebral, cardiovascular and general vegetative disorders.

In Europe and the United States, a clinical classification, which is simple for the choice of patient management tactics, has become widespread, in which GCs are divided into complicated and uncomplicated:

1. Complicated GC are characterized by progressive or acute damage to target organs and pose a threat to the patient's life. They require an immediate (within one hour) decrease in blood pressure (within the first hour by about 15-25%, during the next 2-6 hours - up to 160/100 mm Hg). Then within 1-2 days - reaching target blood pressure levels. Complications of GC will be discussed below.
2. Uncomplicated GCs do not show signs of progressive or acute damage to target organs, but they pose a potential threat to the patient's life. They require a quick (within a few hours) decrease in blood pressure.

In clinical practice, the most widely used division of crises of the first and second order. This classification is based on clinical data, there is no need to use complex and expensive equipment.

Civil Code of the 1st order

Occurs in the early stages of hypertension. This type of crisis is characterized by a rapid onset against the background of a relatively satisfactory condition, pronounced neurovegetative syndrome with agitation, trembling in the limbs, chills, severe sweating, and anxiety.

Throbbing dizziness, nausea, headache, vomiting, and sometimes blurred vision are noted. The face is red or covered with red and pale spots. Typical is tachycardia, high systolic blood pressure (upper) and low diastolic blood pressure (lower). Often there is a feeling of lack of air, pronounced pain in the region of the heart, palpitations. Often there is an increase in urination, after the relief of the crisis, light urine is released in large quantities.

The crisis is short-lived, usually not exceeding 2–4 hours. Complications, as a rule, are absent, but in some cases, paroxysmal arrhythmias, an attack of angina pectoris may occur, and in severe cases, myocardial infarction.

Civil Code of the 2nd order

Occurs in the later stages of hypertension. Develops gradually, lasts longer (from 6 hours to 10 days). Second order hypertensive crisis is accompanied by a number of syndromes:

1. Water-salt or edematous syndrome (water-salt or edematous crisis) - caused by a violation of the RAAS. Drowsiness, lethargy, depression of patients, sometimes disorientation in space and time are noted. The following type of patient is characteristic: a pale puffy face, swollen fingers, swollen eyelids. General symptoms: nausea up to vomiting, severe and increasing headache. There may be focal neurological symptoms: aphasia (lack of speech), amnesia, paresthesia, flickering of "mesh" or "flies" before the eyes, double vision, impairment of hearing or vision. There is a high diastolic pressure (130-160 mm Hg).
2. Epileptiform syndrome (acute hypertensive encephalopathy or convulsive hypertensive crisis) - caused by cerebral edema. It usually occurs during a crisis in patients with a persistent increase in blood pressure. There is a sharp pain in the head, blurred vision, nausea and even vomiting. Systolic blood pressure is more than 200-250 mm Hg, and diastolic blood pressure is more than 120-150 mm Hg. When examining the fundus, edema of the retina, the nipple of the optic nerve, extensive or minor hemorrhages are revealed. There are sensations of paresthesias, disturbances of consciousness, disorders of cerebral circulation, tonic and clonic seizures may occur. The prognosis is poor. This form of course is complicated and has direct indications for hospitalization of the patient.
3. Cardiac syndrome - often develops in patients with concomitant ischemic heart disease. It is based on left ventricular and acute coronary insufficiency. Manifested by a common attack of angina pectoris, progressive angina pectoris, myocardial infarction, cardiac asthma, pulmonary edema or arrhythmias.

It is also a complicated form of HA and should be treated with an acute coronary syndrome protocol.

Complications

Complications of GC directly include (in these cases, transfer to the intensive care unit or intensive care unit at the cardiology emergency department is indicated):

acute coronary insufficiency (angina attack, unstable angina, myocardial infarction);
acute left ventricular failure (heart asthma or pulmonary edema);
disturbances in the rhythm and conduction of the heart;
severe retinopathy (retinal detachment, retinal hemorrhage);
disorders of cerebral circulation;
dissecting aortic aneurysm, ruptured aneurysm;
acute renal failure;
bleeding nose, gastrointestinal, pulmonary, hematuria;
preeclampsia and eclampsia of pregnancy.

Relief of hypertensive crises

With the development of symptoms resembling a hypertensive crisis, it is necessary to measure the pressure. If the numbers meet the criteria for a hypertensive crisis, then therapy should be started. Home treatment is characterized by a very small therapeutic range of drugs. This is because most drugs are not available at the pharmacy and most require intravenous administration in the form of solutions rather than tablets.

As first aid at home, you can take under the tongue (your choice!) Captopril, Nifedipine, Nitroglycerin or Furosemide (either alone or in combination, again, assessing the clinical manifestations of a crisis) or a drug from the group of beta-blockers (Bisoprolol, etc.). After taking the drug, it is worth re-measuring blood pressure after 5-10 minutes. If there is no result, then call an ambulance.

It is irrational and reckless to take medications with HA!

HA therapy will differ depending on the order, the prevalence of a particular syndrome, and the presence of complications. To begin with, an important point should be considered in the treatment of crises - this is the rate of decrease in blood pressure. This point was partially considered in the classification of hypertensive crises:

with uncomplicated blood glucose - it is worth lowering blood pressure by 25-30% in 1-2 hours, then within 1-2 days - reaching target blood pressure levels;
with stroke - it is worth lowering blood pressure within an hour by 25-30%, then further reduction is very careful and long;
with dissecting aortic aneurysm or pulmonary edema - it is worth lowering blood pressure by 25-30% in 10-15 minutes, reaching target levels< 120/80 за 20-30 мин.

The drug of choice for the treatment of 1st order HA is Clonidine, which is given intravenously over 5 minutes. It can be combined with taking Nifedipine under the tongue. With this combination, the effect is achieved in 80% of patients. The remaining 20% \u200b\u200bshould be injected intravenously with Furosemide (Lasix). In pregnant women, the use of a 25% solution of magnesium sulfate intravenously is also shown in the initial stages of hypertension.

In the case of the water-salt form of HA, the combined therapy of Nifedipine under the tongue and diuretics (Furosemide) is recommended. If the effect of such therapy is insufficient, then it is necessary to re-give Nifedipine under the tongue. 10-12 hours after relief, "rebound edematous HA" occurs due to acute activation of the RAAS and the sympatho-adrenal system in response to significant diuresis. To prevent the development of rebound, use Clonidine or Bisoprolol and Captopril under the tongue, repeating the latter every 30 minutes. for 2 hours. If the rebound HA has developed, then Enalapril (Enap) is prescribed intravenously.

With a convulsive form, the drug of choice is sodium nitroprusside, which is administered intravenously. Currently, there is an alternative to sodium nitroprusside - Urapidil (Ebrantil). To reduce cerebral edema, Furosemide (Lasix) or Aminophylline are additionally administered. In order to relieve seizures, magnesium sulfate or Diazepam is administered in parallel.

For the treatment of GC with acute left ventricular failure, the drug of choice is Nitroglycerin. It has also been shown to be combined with intravenous furosemide. A hypertensive crisis, complicated by a paroxysm of supraventricular tachycardia or atrial fibrillation, is relieved by one of the following drugs: Verapamil intravenously in a stream for 1-2 minutes or Novocainamide intravenously for 3-5 minutes.

In the case of the development of cardiac or epileptiform syndrome, as well as with very high blood pressure values, an ambulance must be called.

Under hypertensive crisis understand all cases of sudden and significant increase in blood pressure (BP), accompanied by the appearance or aggravation of already existing cerebral, cardiac or general vegetative symptoms, 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 separation of crises of the first and second order is most widely used in the practice of therapists.

Hypertensive crisis of the 1st order

It is characterized by a rapid onset against the background of a relatively satisfactory state of health, pronounced neurovegetative syndrome with agitation, chills, trembling in the limbs, anxiety, severe sweating. There is a throbbing headache, dizziness, nausea, vomiting, and 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, 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. As a rule, there are no complications.

Second order hypertensive crisis

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. There is lethargy, drowsiness, depression of patients, sometimes disorientation in time and space. The type of patients is characteristic: a pale puffy face, swollen eyelids, swollen fingers. General symptoms: severe and increasing headache, nausea and vomiting. There may be transient focal symptoms: aphasia, amnesia, paresthesia, diplopia, the appearance of "flies", "mesh" before the eyes, deterioration of vision, hearing. High DBP (130–160 mm Hg), low pulse pressure, hypokinetic type of central hemodynamics are noted. Muffled heart sounds, accent of the II tone above the aorta. On the ECG signs of systolic overload: depression of the ST segment, 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. Sharp headache, nausea, vomiting, visual impairment. SBP - more than 200–250 mm Hg, DBP - more than 120–150 mm Hg. When examining the fundus, edema of the nipple of the optic nerve, retina, small or extensive hemorrhages are found. Sensations of parasthesia, disturbances of consciousness quickly arise, TIA, strokes, tonic and clonic seizures may occur. Subdural and subarachnoid hemorrhages are common. The prognosis is poor.

Cardiac syndrome.It develops more often in patients with concomitant ischemic heart disease. It is based on acute coronary and left ventricular failure. Manifested by angina pectoris, progressive angina pectoris, MI, cardiac asthma, pulmonary edema, or cardiac arrhythmias.

Complications of a hypertensive crisis

1. Acute coronary insufficiency (angina attack, unstable angina, 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, ruptured aneurysm.
6. Severe retinopathy, retinal detachment, retinal hemorrhage.
7. Acute renal failure due to fibrinoid necrosis of renal vessels.
8. Bleeding nasal, pulmonary, gastrointestinal, hematuria.

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

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

Treatment of hypertensive crises

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

2. Ensuring adequate control over the patient's condition during the period of blood pressure decrease. Timely diagnosis of complications or excessive decrease in blood pressure is required.
3. Consolidation of the achieved effect. For this, the same drug is usually prescribed, with the help of which blood pressure was reduced, if impossible - other antihypertensive drugs. Time is determined by the mechanism and duration of the selected drugs.
4. Treatment of complications and concomitant diseases.
5. Selection of the optimal dosage of drugs for maintenance treatment.
6. Carrying out preventive measures to prevent crises.

Indications for planned hospitalization of hypertensive patients:

1. unclear diagnosis and the need for special, more 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 pronounced manifestations of hypertensive encephalopathy;
3. complications of hypertension requiring intensive therapy and constant medical supervision: MI, subarachnoid hemorrhage, acute visual impairment, pulmonary edema.

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Moreover, there are two types of crises:

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

Therapeutic tactics for both types are significantly different, because they are based on different mechanisms of their provocation. Therefore, the faster the treatment regimen is completed, the more beneficial 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, one should correctly monitor the level of one's blood pressure, especially for the elderly, as well as for patients suffering from stage III arterial hypertension with chronic heart failure.

With such a pathology as a hypertensive crisis, treatment should be started with simple techniques, having analyzed the dynamics of pressure. If it has increased within a few hours, then the crisis will be neurohumoral. If, for several days, the pressure increased, which is 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 blood pressure in response to emotional stress or excessive exercise. For this reason, the most specific drugs should be taken: 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 the onset of the effect in this case is very long, and therefore, to quickly reduce the 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.

Interestingly, clonidine can also be used to rapidly lower blood pressure. However, it is not always available in the first aid kit 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 admissions office with the help of relatives. After that, the patient will be referred for inpatient treatment, designed to lower blood pressure and revise the tactics of basic hypertension therapy.

Concept of pre-medical treatment

Captopril under the tongue;
Orally enalapril (or lisinopril);
Oral beta-blockers;
Nitroglycerin under the tongue 1 tablet without repetition (it can be repeated only if there is angina pain within 5-7 minutes from the tablet resorption. If the pain persists later and does not stop after the second tablet, a third one is used. If the pain continues, then we should talk about a heart attack myocardium developed due to increased load on the heart against the background of cardiosclerosis or coronary artery disease).

Treatment of type II hypertensive crisis 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 for the purpose of vasodilation. 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. The expansion of blood vessels 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 taking 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 the 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 considered. And then the treatment should be appropriate.

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

Schematic diagram of first aid for type II vascular crisis:

Taking captopril under the tongue;
Taking enalapril (or lisinopril) orally;
Taking furosemide orally, intramuscular injection is also possible;
Taking beta-blockers orally.

Qualified treatment

With a pathology such as a vascular crisis, 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. Decoding 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 prescribed treatment according to indicators of general well-being and blood pressure levels. The type of crisis is also important. In a neurohumoral crisis, the main drugs for treatment are beta-adrenergic receptor blockers, long-acting ACE inhibitors (enalapril and lisinopril), calcium channel blockers. Diuretics can be prescribed as components of adjuvant therapy, but they are not specific for treatment. In parallel, the treatment of concomitant disorders, as well as complications, is prescribed. All this allows you to achieve a competent decrease in the level of pressure and stabilize its indicator.

With a water-salt crisis, the main drugs for qualified therapy are diuretics. A complex of them may 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 the abdomen and lower extremities. Eliminating them 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 had not taken any drugs before admission.

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

This tactic helps to reduce the likelihood of ischemic strokes, which will subsequently protect the patient from this pathology and a long period of rehabilitation. Therefore, even at the moment of pressure stabilization, patients must 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 1 and 2 orders

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

The etiology of development is acute nervous or mental stress, excessive consumption of alcoholic beverages, a sharp drop in atmospheric pressure, the abolition of drugs with an antihypertensive effect, etc.

Given the many reasons and provoking factors, 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 the hypertensive crisis is classified, and what symptoms indicate its development? How is the treatment carried out, what preventive measures are recommended?

Classification of hypertensive crisis by type of blood pressure and the nature of violations

The types of hypertensive crisis, depending on the type of increase in blood pressure, are divided into a systolic type, when an increase in upper blood pressure occurs, and a 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 - the systolic-diastolic view.

Depending on what kind of hemodynamic disturbances are observed, an attack in a hypertensive patient is hypokinetic and hyperkinetic.

In the first variant, the syndrome grows gradually, the course is characterized by pronounced 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

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

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 hypertensive disease.

Types depending on the formation mechanism

The types of hypertensive crisis, depending on the mechanism of the formation of the attack, are divided into cerebral and sympathetic-adrenaline.

Sympathetic-adrenaline or hypertensive crisis of the 1st type proceeds against the background of a significant increase in systolic parameters, the heart rate increases, and the glucose values \u200b\u200bin the patient's body increase.

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

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

Headaches.
An attack of nausea (vomiting is rare).
Visual impairment.
Rapid heartbeat.
Pain in the sternum of a stabbing nature.
Severe anxiety, panic, causeless fear.

At the end of the hypertensive attack, the patient may have abundant stool 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 overwhelming majority of clinical pictures appear not as a disease of the cardiovascular system, but as a transformation of venous tone. A blood test shows a high concentration of adrenaline, while norepinephrine is normal or decreases.

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

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

Strong headache.
Drowsiness.
General malaise.
Weakness.
Feeling of general disorientation.
Attacks of nausea, up to vomiting.
Decreased heart rate (sometimes).

With an excessive severity of the clinical picture, loss of consciousness with subsequent complications is not excluded.

Almost all patients note painful sensations in the region of the heart, which are accompanied by increasing shortness of breath, asthma of a cardiac nature is not excluded. In about 50% of pictures in urine, a large amount of protein substances and red blood cells are detected.

On electrocardiography, severe left ventricular failure is diagnosed.

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. With an attack of the neuro-vegetative order, patients suffer from increased anxiety, irritability and excitement, anxiety.

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

In the case of the water-salt type, patients, on the contrary, are overly 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, the indicators of systolic and diastolic pressure increase. The following symptoms are the harbingers of a pathological condition:

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.

With types 1 and 2 of hypertensive seizure, patients may have a violation of the sensitivity and motor activity of the lower extremities, face and tongue.

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

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

Improvement of the general condition is 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 \u200b\u200bgradually in order to neutralize the likely negative impact on the functionality of the kidneys and brain. It should be noted that it will not work to lower the pressure without the pills.

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 uncomplicated form, you can take Nifedipine, an oral drug that provides a quick but short-term decrease in blood pressure. The dosage ranges from 5 to 10 mg under the tongue. If the therapeutic effect is insufficient for half an hour, repeat the reception. The total limiting dose should not exceed 30 mg.

Captopril is a drug that provides 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 funds may be recommended:

Beta-blockers.
Medicines with antihypertensive effect.
Calcium antagonists.
ACE inhibitors.
Diuretics.

Treatment should be started at the first symptoms of a crisis. Ignoring the situation leads to heart attack, angina pectoris, cerebral hemorrhage, renal failure, and 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 quit smoking, drinking alcoholic beverages, 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 obtained in a diary, which allows you to track the dynamics of the jumps. The patient needs to take all medicines that the doctor recommended.

It is advisable to emphasize that medications are aimed at lowering blood pressure and stabilizing it at the required level. Even after the required result is achieved, it is not necessary to refuse taking medications, only the doctor can remove the appointment.

Diet has a dominant role in the prevention of hypertensive attacks. For vascular ailments, he showed table number 10. The diet implies the exclusion of all food products that increase vascular tone and irritate the central nervous system.

Excluded from the menu:

Fried and spicy food, coffee, tea, alcoholic drinks.
Limiting table salt to 5 grams per day, and it is better to completely abandon the crystal powder.
With obesity, the daily calorie content of the diet decreases.
Fatty meats and fish are excluded.

A hypertensive crisis is a complication of arterial hypertension that is almost impossible to predict. Despite the well-proven algorithm for arresting an attack, it is better not to bring it to him through daily monitoring 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 blockages in the arteries of the heart or brain.

Especially scary is the fact that many people do not even suspect that they have hypertension. And they miss the opportunity to fix something, simply dooming themselves to death.

Headache
Increased heart rate
Blackheads in front of the eyes (flies)
Apathy, irritability, drowsiness
Blurry vision
Sweating
Chronic fatigue
Swelling of the face
Numbness and chills in the fingers
Pressure surges

Even one of these symptoms should be thought provoking. And if there are two of them, then do not doubt - you have hypertension.

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1. Hypertensive crisis of type 2 (complicated) in hypertension: diagnosis, treatment.

A significant, sudden increase in blood pressure with neurovascular and humoral disorders. The emergence of hypertensive crises is facilitated by acute neuropsychic stress, 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 "fog" before the eyes, nausea and vomiting. A characteristic feature of a hypertensive crisis is a feeling of heaviness behind the breastbone. A hypertensive crisis can occur suddenly while feeling well.

With a large variability of the clinical manifestations of a hypertensive crisis, hyperkinetic and hypokinetic crises are distinguished for adequate emergency care, depending on the characteristics of central hemodynamics. With a hyperkinetic crisis, an increase in blood pressure is mainly due to excessive work of the heart (an increased cardiac index). In a hypokinetic crisis, the main mechanism for increasing blood pressure is increased peripheral resistance. When providing emergency care, the doctor is not able 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 types I and II and complicated

Type II hypertensive crisis (hypokinetic) more often develops in patients with stage 11B-III hypertensive disease with insufficiently effective treatment or violation of the lifestyle. The symptoms of a crisis develop more slowly, but very intensely. Within a few hours, the headache increases (sharpest). Nausea, vomiting, lethargy appear, vision and hearing deteriorate. The pulse is tense, but not quickened; Blood pressure is sharply increased, mainly diastolic (dom Hg. Art.). ECG shows 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 urine, especially at the end of a crisis, there is a significant amount of protein, casts and red blood cells.

Complicated hypertopic crisis can proceed according to the cerebral, coronary or asthmatic variant. In contrast to uncomplicated hypertensive crisis, with complicated variants of the 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 disturbance , 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 5-20% glucose solution, a pronounced hypotensive effect occurs. After the introduction of clonidine, the patient should stay in bed for 1-2 hours. In a hospital setting, especially in elderly patients, it is desirable to drip intravenous clonidine during the course of the min.

Fast hypotensive effectt gives an intravenous jet injection of 20 ml of hyperstat (diaxizone). A decrease in blood pressure occurs within the first 8 minutes and is maintained for several hours. Diazoxide should be used with great caution 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 1% mezaton solution. Effectively reduces blood pressure in hypertensive crises, receiving under the tongue 0.01 gcorinfar (nifedipine).

For relief of complicated type II crisis with a moderate increase in blood pressure, neuroleptic drugs can be used. With a slow intravenous injection 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, well-being quickly improves and blood pressure decreases. The beneficial effect begins to manifest itself after 2-4 minutes and becomes more pronounced in the first minute. However, the effect is short-lived - up to 1 hour. To enhance the hypotensive effect of droperidol, it is advisable to prescribe oral diuretics in combination with antihypertensive drugs.

With a hypertensive crisis with a significant increase in blood pressure and signs of acute left ventricular failure intravenous administration of ganglion blockers and diuretics is advisable. A quick effect occurs with intravenous drip administration of 1-2 ml of 5% pentamine solution in ml of 5-20% glucose solution or isotonic sodium chloride solution at a rate of drops per minute. The hypotensive effect occurs after a minute and lasts for an hour. One should strive to immediately reduce systolic blood pressure in the first minutes by 25-30% compared to the initial level. In the future, blood pressure should be measured every 5-10 minutes for an hour while the patient is in a horizontal position. If it is impossible to introduce drip, pentamine can be injected slowly intravenously (within 7-10 minutes) - 0.5-1 ml of 5% solution in 20 ml of 5-20% glucose solution with continuous monitoring of blood pressure.

With the jet injection of pentamine, especially in the elderly, a collaptoid state may develop. If it occurs, it is necessary to inject intravenously 0.5 ml of a 1% solution of mezaton. With general arousal, the administration of ganglion blockers can be combined with droperidol, which eliminates arousal and enhances the hypotensive effect of ganglion blockers.

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

hemocytopenia is a disorder of hematopoiesis. 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: By development mechanism: 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 folate deficiency; hypo-, aplastic and metaplastic. By the type of hematopoiesis: normoblastic; megaloblastic. According to the color indicator, 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 higher than 1.05.

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

Iron deficiency anemias associated with iron deficiency in the body. Clinical presentation: lethargy, increased fatigue even before the development of severe anemia, constipation, headache, taste perversion, fragility, curvature and cross-striation of nails, hair loss, urge to urinate, urinary incontinence, pale 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 (norm mmol / l for men; mmol / l for women).

Hereditary anemiasassociated with impaired synthesis of porphyrins (sideroachrestic anemias) are characterized by hypochromia of erythrocytes, an increase in the level of serum iron, iron deposition with a picture of hemossiderosis 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 disorders. Complaints about weakness, fatigue. Men suffer more often. The disease is inherited in a recessive manner, inheritance is linked to the X chromosome. At the beginning of the disease, a slight increase in the spleen is sometimes noted, later, due to the increased deposition of iron in the organs, hemosiderosis of the liver develops (the liver increases and becomes dense), of the pancreas (a picture of diabetes mellitus appears). The accumulation of iron in the heart muscle leads to severe circulatory failure, hemosiderosis of the testicles 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 marked anisocytosis, poikilocytosis, sometimes a small number of target-like forms. The reticulocyte count is usually normal. Other blood counts are normal.

Megaloblastic anemias - a group of anemias, the common feature of which is the detection in the bone marrow of peculiar erythrokaryocytes with structural nuclei that retain these features at the late stages of differentiation (the result of a violation of 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.

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

Hemolytic anemias associated with increased destruction of erythrocytes, an increase in the blood content of erythrocyte breakdown products - bilirubin or free hemoglobin, or the appearance of hemosiderin in 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 - jaundice, 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.

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

At the heart of crises of the first type is more often a psychoemotional factor, therefore they develop without visible organic prerequisites in stage I or II of hypertension and last from several minutes to 2-3 hours.The crisis begins suddenly, usually against the background of the general well-being of patients: a sharp headache appears , often of a pulsating nature, flashing of "flies", netting, veils before the eyes, double vision, sometimes patients may temporarily lose their eyesight.

They are usually agitated, irritable, often extremely anxious, feel hot and dry in the mouth, cold extremities, tremors throughout the body. Complaints of palpitations, stitching pains in the region of the heart, feeling of shortness of breath are also characteristic.

There is hyperemia of the skin of the face, neck and hands, alternating in many cases with pallor, followed by the appearance, especially in the chest, of red spots, separate areas of hyperesthesia and less often skin hypesthesia, sweating. The body temperature rises slightly (usually by no more than 1 degree).

The pulse quickens, becomes more tense, the volume of the heart sounds rises. 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 an increase in pulse pressure.

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

Crises of the second type are observed in patients with hypertensive disease III and less often IIB stage. Unlike crises of the first type, they develop slowly, last 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 pronounced symptom complex and a high initial level of blood pressure.

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

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

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, pain occurs in the area of \u200b\u200bthe heart of an angina pectoris, accompanied by focal lesions of the myocardium.

First aid for hypertensive crisis, its relief.

Common causes of a hypertensive crisis:

Eating a lot of salty foods;

A large amount of fluid you drink;

Long break in food intake, overeating;

With the onset of symptoms of a hypertensive crisis, you must call an ambulance. A hypertensive crisis usually develops very quickly and it should be borne in mind that urgent hospitalization of the patient may be required. This is especially important if there are signs of a complicated hypertensive crisis or if the patient has a hypertensive crisis for the first time.

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

An extra dose of the medicine he usually takes to lower blood pressure should be given immediately. But it should be borne in mind that if the treatment was carried out with drugs of prolonged (long) 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). Relief of a hypertensive crisis involves a decrease in pressure within 1 hour namm Hg. Art. compared to the original. It is important to give a diuretic, but you must first know which drug is allowed. with some concomitant diseases, some drugs are contraindicated. For example, in type 2 diabetes mellitus and its treatment with metformin, it is forbidden to use the common furosemide.

IMPORTANT! For the relief of hypertensive crises, it is necessary to discuss the actions with the doctor immediately - when establishing the diagnosis of HYPERTENSION. If you do not possess such knowledge, then you need to consult a doctor in the near future, before the onset of a hypertensive crisis. since perhaps an individual approach is needed depending on the concomitant chronic diseases that 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 when a person develops a condition in which the systolic pressure in the arteries exceeds 220 mm Hg, and the diastolic pressure exceeds 120 mm Hg and is accompanied by neurological disorders and damage to internal organs.

The frequency of occurrence 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. With 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 crises 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 the dynamics of cardiac output, and a moderate change in the greater side of 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 a decrease in ejection and an increase in 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 coronary blood flow.
Cardiac asthma.

In addition, a complicated hypertensive crisis may be accompanied by acute circulatory failure of the brain (ACV), strokes, and in some cases, even a 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, the development of aphasia. Also, against the background of a violation of the permeability of the vessels of the brain and the development of its edema, a convulsive state with loss of consciousness is possible.

Hypertensive cerebral crisis (cerebral) should be singled out separately. Its occurrence is explained by a 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 ischemic manifestation is associated with insufficient oxygen supply to the brain tissues, which occurs due to spasm of the cerebral arteries. In the event that there is a complex type of cerebral crisis, we should talk about both mechanisms.

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

An abrupt start.
Thirst.
Redness of the skin.
Nausea and headache.
Flashing "flies" before the eyes.
Change in heart rate as a tachycardia.

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

Not a sharp start.
Lethargy.
Severe edematous syndrome.
Vomiting.
The appearance of paresthesias.

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

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

The ECG shows depression of the S-T segment. In the analysis of urine, proteinuria and rarely cilinduria are possible. Cutting off this option is not difficult, and it itself 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 the wrong therapy, its duration can be several days. The pain syndrome is much more pronounced and symptoms of cranial nerve damage can be attached to it.

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

Causes of a hypertensive crisis and risk factors

A hypertensive crisis most often develops against a background of strong psychoemotional stress. In addition, the following factors can become the reasons for the development of a hypertensive crisis:

Change of weather conditions.
Drinking alcoholic beverages.
Violation of the diet.
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, do not suddenly stop taking it. This can lead to complications.
Frequent lack of sleep.
Excessive physical activity.
Exacerbation of concomitant chronic pathologies (Hypertension grade 2, diabetes mellitus).

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

Sometimes this condition can be confused with pre-eclampsia of pregnancy. But this is wrong. So, the possibility of developing a crisis occurs at any period 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 for those cases when hypertension is complicated by atherosclerotic vascular changes.

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

So that this condition is not taken by surprise, you need to know its main manifestations, namely:

Rapid increase in pressure.
Pain syndrome localized in the occipital region
Complaints about "flies" before the eyes.
Confusion of gait.
Dizziness.
Lack of air.
Feeling nauseous.
Vomiting.
Palpitations.

It is extremely important to understand that when you are near a person who complains of one or more of the signs, you need to seek medical help as soon as possible. The sooner the ambulance arrives, the earlier the necessary treatment will begin, and, therefore, the lower the risk of possible complications. A disease such 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 postponed hypertensive crisis in people with grade 3 hypertension ends in death. When asked about the danger of a hypertensive crisis, the classification of possible complications gives comprehensive information. Usually doctors use two types of classification - by the type of crisis and by 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 distinguishes:

type 1 hypertensive crisis;
type 2 hypertensive crisis;
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. Typically, this type 1 crisis is experienced by people with grade 1 and 2 hypertension.

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

Complicated crisis according to Ratner threatens not only the health, but also the patient's life. Potential consequences include pulmonary edema, loss of vision, stroke, or heart attack. This condition requires immediate hospitalization.

In most cases, only calling an ambulance gives you a chance to avoid dire consequences

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

Type 1 crisis

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

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

Symptoms of the 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 the lower pressure remains within the normal range or slightly exceeds it (usually the value is mm Hg).

A hypertensive crisis or type I hypertension is quickly relieved at home. Its causes most often lie in the patient's psycho-emotional state. The crisis develops against a background of stress, emotional stress, physical exertion. The impetus for the development of a crisis can 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 work of internal organs. The first type of crisis is characteristic of patients with hypertension of 1 and 2 degrees. Most often found in young people.

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

Type 2 crisis

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

Specific symptoms of such a crisis:

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

Blood pressure reaches critical values. In this case, the lower indicator often increases many times, which indicates a high risk of disruption of the target organs. In a type 1 crisis, the pulse pressure is usually higher than normal, that is, the difference between the upper and lower values \u200b\u200bis 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 crisis is faced by older patients who have been living with essential 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 of a crisis

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

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

The presence of complications distinguishes between complicated and uncomplicated crises.

Uncomplicated crisis

A type 1 crisis and an uncomplicated crisis are the same thing. With the development of such a condition, a rapid increase in blood pressure is noted, but there is no immediate risk to the patient's life. Due to the fact that the pressure increases 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 quickly enough.

An uncomplicated crisis can be recognized by the absence of chest pain and tachycardia. If the pulse rate rises 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 able to successfully circulate blood even with high blood pressure.

In such a hypertensive condition, emergency care corresponds to the measures carried out for type 1 hypertensive crises. The patient should calm down, take a comfortable position and take the pressure medication. Uncomplicated hypertensive crisis resolves within a few hours.

A high heart rate and no heart pain 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 impaired cerebral circulation. In severe cases, this condition leads to cerebral edema and coma.

Possible consequences of such a crisis:

pulmonary edema;
hypertensive angiopathy;
cerebral stroke;
hypertensive encephalopathy;
myocardial infarction;
fatal outcome.

With 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 knock 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 for high blood pressure occur annually. 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.

Allocate hypertensive crises of types I and II

Type 1 hypertensive crisis

1. Occurs in the early stages of GB, mainly in young people
2. Development is acute (in 1 - 2 hours), more often after stress, for a short time (3 - 4 hours)
3. Preferential growth of systolic blood pressure
4. The main mechanism of the crisis: cardiac,
5. Complaints of sharp, nausea, vomiting, palpitations, tremors, chills, fear, agitation with vegetative manifestations: red spots on the body, a feeling of heat, increased sweating
6. Complications - rare

Type 2 hypertensive crisis

1. Occurs in the late stages of hypertension in the elderly, patients "with experience"
2. Development is gradual, lasting up to several (4 - 5) days
3. A predominant increase in diastolic blood pressure
4. The main mechanism of the crisis is an increase in vascular tone with the development of edematous syndrome,
5. Complaints of headache, nausea, vomiting, deafness, lethargy, staggering when walking, hearing impairment, vision impairment, impaired sensitivity, muscle strength
6. Complications - often