The instability of blood pressure worries a lot of people. Some suffer from constant jumps in the tonometer up and down, others are worried about strong low pressure, and still others are tormented by a noticeable increase in numbers on the mercury column. The latter situation is related to the hypertensive crisis. How does this pathological process manifest itself and its causes? Let us consider in more detail the types of hypertensive crisis.

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Causes

Each stage of hypertension can provoke a hypertensive crisis. Cases have been recorded when the disease was noted in people who do not have health problems. But most often, this is a consequence of neglected hypertension in combination with atherosclerosis. If the symptoms of such an ailment bother a person repeatedly, then this is often the result of a negligent attitude to treatment or its complete absence.

Factors contributing to the development of the disease:

• hard physical labor;
• weather change;
• hormonal disbalance;
• refusal to take drugs that help reduce pressure;
• abuse of coffee, alcohol;
• eating salt and salty foods in large quantities;
• overexertion and stress.

Pathology, manifested against the background of atherosclerosis, is a consequence of impaired blood circulation of the vessels of the cerebral cortex. Most often it develops in elderly people, the disease accompanies many unpleasant symptoms. In old age, the disease is quite severe.

Important! Much more often, the disease manifests itself in kidney dysfunction, diseases of the autoimmune system, characterized by inflammation of the arteries (polyarthritis nodosa), diabetes mellitus of various types, pathology during pregnancy - nephropathy, disorders in the immune system, characterized by inflammatory processes in organs and tissues (lupus erythematosus), as well as atherosclerosis of the aorta and its branches.

Symptoms

The main symptom of a hypertensive crisis is a sudden increase in blood pressure readings on a tonometer. With overestimated levels of the mercury column in a person, cerebral and renal circulation deteriorates, and cardiovascular diseases become the result of such changes in the body. As a rule, many patients are brought to the hospital with a heart attack, stroke, acute coronary insufficiency and other diagnoses.

With this ailment, the pressure can reach the following indicators: 220/120 mm Hg, but this is not the limit, sometimes there is a jump even higher.

Signs of pathology:

• fussiness, impulsivity, shouting out of phrases (all symptoms of acute mental illness expressed in motor activity) are manifested;
• the patient feels an inexplicable feeling of anxiety and anxiety;
• signs of tachycardia develop noticeably (heart rate increases);
• the patient cannot breathe normally, he does not have enough air;
• a person shudders, he begins to shiver;
• hands are shaking and trembling;
• face reddens and swells;
• headache;
• vomiting and nausea.

Important! Complications may occur: pulmonary edema, coma, thrombosis, acute renal failure, accompanied by an increase or decrease in urination.

As you can see, the symptoms of the disease are different, but the most common symptom is a headache. With the development of pathology, headaches are even divided into types: typical, atypical, and pains that are noted in malignant hypertension. The degrees of the disease also have differences and are able to make themselves felt in different ways. So, what are the degrees and types of the disease?

Hypertensive crisis type 1

The development of this type is typical for patients with stage I and II hypertension. An attack of a sharp increase in pressure occurs suddenly, there are no foreshadowing signs. The duration of the crisis is 60-180 seconds.

Usually the patient is overtaken by a sharp pain, a grid appears before the eyes, which interferes with vision. At this point, the patient is very agitated, his skin becomes mottled and changes color. There were cases when the appearance of a rash was noted. During a crisis, the patient dries, the skin on the lips bursts. Body temperature rises, pulse and blood pressure increase.

Hypertensive crisis type 2

The second degree is characteristic of patients with stage III hypertension. This type of crisis lasts much longer - from several hours to 5 days. The patient during this period is not able to cope with soreness and discomfort. He is terribly tormented by headaches, his head is spinning and getting heavy. In a hypertensive crisis of the 2nd degree, people experience nausea, vomiting, they are worried about drowsiness, but they cannot sleep. In addition, patients noticeably deteriorate hearing and vision. All these symptoms are reinforced by suffocation.

In appearance, patients during this period are very weak. They may experience lethargy and lack of desire for various movements. The skin of the face acquires a blue tint, becomes dry and cold.

The pulse is usually slow, but can sometimes be slightly quickened. The indicators on the tonometer are overestimated, but lower than in the hypertensive crisis of the 1st degree.

Important! Despite the fact that both degrees of the disease have the same symptoms, however, they differ from each other.

Type 1 and 2 - what's the difference

Initially, scientists looked for differences between the two types of diseases at the level of the reaction of the cerebral cortex and subcortical regions, but the studies were not successful. Then their attention was turned to the sympathetic-adrenal system. It was here that it was found that with degree 1, the secretion of adrenaline by the adrenal glands increases, and the second type provokes the production of norepinephrine.

If adrenaline is administered to a person, then it will be possible to track all the symptoms of increased heart function. The same symptoms appear in type 1 hypertensive crisis: fever, trembling, rapid heartbeat.

Norepinephrine, in turn, does not affect the pulse, blood circulation and metabolism. Therefore, during a type 2 hypertensive crisis, the “suppression” of the pulsation occurs, the sugar level remains unchanged, but at the same time the mercury column increases, there are noticeable changes for the worse in the activity of the heart and central nervous system.

Important! With a lot of differences in the symbols of the manifestation of the disease and the totality of the processes that determine its outcome, hypertensive crisis of 1 and 2 degrees is considered as a single pathology.

brain type

Often the result of a hypertensive crisis is a stroke. However, disabled brain functions last for a while, and then resume their activity. It is impossible to say unequivocally that a stroke should be preceded by a crisis. But often this is exactly what happens - this is a fact. There are 2 types of brain crisis.

1. I view. This species is characterized by headache, vomiting, nausea. With it, increased pressure is noted in the temporal artery and retinal vessels.
2. II view. There are more severe symptoms that lead to loss of consciousness.

Symptoms of the second type are more consistent with the manifestation of a hypertensive crisis.

Classification according to the mechanism of increasing blood pressure

Hypertensive crisis can be divided into different types and types, starting from different factors. According to the mechanism of pressure increase, there are: eukinetic, hyperkinetic and hypokinetic crisis.

hyperkinetic type

Usually develops in stage I and II hypertension. No foreshadowing symptoms are noted in the patient, the crisis comes quickly and without warning. This process is accompanied by an increase in cardiac output, as well as peripheral vascular resistance, which remains unchanged or decreases.

Hypokinetic type

Stages II and III of hypertension are characteristic. The pathological process develops gradually. In this type of disease, peripheral vascular resistance increases and cardiac output decreases. This type is often a harbinger of a stroke.

eukinetic crisis

This type of crisis corresponds to stages II and III of hypertension and the secondary form of hypertension. The eukinetic crisis comes upon the patient unexpectedly, but its symptoms are not as pronounced as in the hyperkinetic type of crisis. This species is characterized by normal cardiac output, but increased peripheral vascular resistance.

Prevention

To reduce the risk of developing a hypertensive crisis, it is necessary to observe preventive measures, they are identical to measures to prevent hypertension. It is important to monitor your blood pressure. Timely start treatment of hypertension. With the development of pathology, it is necessary to know the cause in order to exclude, if possible, a negatively affecting factor.

The main preventive measures are: rational nutrition, adherence to the regimen, rest. Stressful situations must be avoided. Moreover, it is important to follow all the prescriptions of the doctor.

• the first type;
• second type;
• complicated;
• uncomplicated.

• myocardial infarction;

• hyperkinetic;
• hypokinetic;
• eukinetic.

• speech disorder;
• paralysis of the body is unilateral.

• convulsive;
• hydropic;
• neurovegetative;
• adrenal.

• bouts of vomiting, nausea;
• fear and anxiety;
• overexcitability of the central nervous system;
• hyperemia of the face;
• palpitations and pain in the heart;

Treatment of a hypertensive crisis

Conclusion

A hypertensive crisis is a rapid surge in pressure in the arteries, followed by damage to target organs. It arises due to a failure of the mechanisms of regulation of blood pressure, with an incorrect assessment and treatment tactics for hypertension (hypertension).

Classification of hypertensive crises

The classification of hypertensive crises was developed in 1956. Hypertensive crises, the classification of which involves dividing them according to the clinic, the speed of the course, the attack of organs and the effect on the organs of the CCC (cardiovascular system), is diverse. There are such typical crisis conditions in hypertension:

• the first type;
• second type;
• complicated;
• uncomplicated.

Hypertensive crisis of type 1 (otherwise - the first order) is observed more often with 2 degrees, as well as 3 degrees of GB. It develops rapidly, has pronounced vegetative disorders. The first type is manifested by such symptoms: sensation of hot flashes, palpitations, psychomotor agitation, fever, pain in the head.

Hypertensive crisis type 2 flows slowly, occurs against the background of a long-term GB with clear signs of progressive heart failure and swelling of the brain.

The second and most up-to-date classification of hypertensive crises conditionally divides into those with complications and those in which they are absent.

A complicated crisis is formed during an acute progressive attack of target organs against the background of a strong increase in blood pressure in the arteries. After such a crisis, there is a high risk of complications. These are the manifestations:

• ischemic or hemorrhagic stroke;
• myocardial infarction;
• hypertension of the kidneys with a tumor of the adrenal glands;
• bleeding in acute dissection of an aortic aneurysm;
• hypertension in pregnant women with gestosis (preeclampsia and eclampsia).

There are also seizures, changes in consciousness, visual and hearing impairment, high pressure inside the skull.

Such serious conditions, especially those that arose for the first time, require the urgent administration of drugs that reduce blood pressure and hospitalization of the patient in the intensive care unit.

An uncomplicated hypertensive crisis can occur with grade 2 hypertension, characterized by high blood pressure without organ damage. The pathological condition may have an asymptomatic course or single manifestations, such as pressing pain in the head, chest pain, rapid heartbeat, buzzing in the ears, flickering in the eyes, frequent urination.

The existing risk of complications is minimal, but without the necessary treatment, target organ damage is likely.

In patients with a hypertensive crisis, as a result of changes in hemodynamics, the following types of uncomplicated hypertensive crises are distinguished:

• hyperkinetic;
• hypokinetic;
• eukinetic.

A hyperkinetic crisis is formed at 1 and 2 degrees of GB, it is accompanied by a large ejection of the heart at high rates of systolic pressure. The condition is manifested by a sharp pain in the head, flickering points in the eyes, bouts of nausea and vomiting. Patients are overexcited, complain of trembling of the whole body, frequent heartbeat and pain in it.

Hypokinetic crisis develops with grade 3 hypertension. It is accompanied by decreased cardiac output, high pressure levels during diastole. A hypokinetic hypertensive crisis is accompanied by such symptoms: increasing pain in the head, vomiting, drowsiness and lethargy, impaired functions of the hearing organs, as well as vision, bradycardia (slow heart rate).

Eukinetic crisis occurs at stages 2 and 3 of hypertension of the 2nd degree. It is characterized by normal cardiac output at high pressures during systole and diastole. With a hypertensive crisis of this type, there is pain in the head, bouts of vomiting, impaired movement.

Cerebral hypertensive crisis is caused by an acute circulatory disorder in the brain and blood vessels. Possible with 2 degrees, 3 degrees of GB. The source of its occurrence can be a stroke and hypertensive encephalopathy. It has an acute development with a high jump in blood pressure. In a cerebral hypertensive crisis, an unbearable headache, bouts of vomiting, a change in consciousness in the form of a stupor or stunning occur. In addition, epileptic seizures are possible.

There are ischemic and hemorrhagic strokes. They have the following features:

• numbness of half of the face and limbs;
• sudden blurred vision;
• debilitating pain in the head with nausea and vomiting;
• speech disorder;
• change in coordination, as well as body balance;
• paralysis of the body is unilateral.

Since these conditions threaten the life of the patient, urgent medical intervention and constant monitoring of the person who has undergone a crisis are required. Classification of attacks of hypertension listed types is not limited.

So, the following types of hypertensive crisis are additionally distinguished:

• convulsive;
• hydropic;
• neurovegetative;
• adrenal.

Hypertensive crisis, the types of which are numerous, has a variety of symptoms. The onset of a neurovegetative hypertensive crisis is characterized by increased anxiety, nervousness, excessive sweating, and frequent heartbeats. Such a clinic can last several hours.

Edematous hypertensive crisis is characterized by pallor of the skin of the face, hands, their edema, inhibited, drowsy and depressed state, disorientation in space.

Convulsive hypertensive crisis is the most dangerous and severe among all listed. Its definition is not difficult. This condition, characterized by swelling of the brain, usually lasts about two days. At the peak of the crisis, convulsions and loss of consciousness occur.

Adrenal crisis develops against the background of panic attacks and disorders of the autonomic nervous system. It is characterized by severe panic and anxiety. An adrenal crisis is manifested by tachycardia, shortness of breath, tremor of the extremities. As a rule, it develops at stage 2, as well as 3 degrees of GB.

Symptoms of a hypertensive crisis

Hypertensive crises of different types are also characterized by common manifestations:

• soreness of the head of different localization and strength;
• bouts of vomiting, nausea;
• fear and anxiety;
• overexcitability of the central nervous system;
• hyperemia of the face;
• internal trembling of the whole body and limbs;
• palpitations and pain in the heart;
• pathology of the visual and auditory analyzer.

Such symptoms, to one degree or another, manifest themselves in a hypertensive crisis of various genesis.

Treatment of a hypertensive crisis

There are algorithms and standards for the provision of care for HC, approved by WHO. To eliminate any hypertensive crisis, you need to act clearly, quickly.

1. With the initial symptoms of a hypertensive crisis, immediately call an ambulance to the patient.
2. Before the arrival of the doctor, the patient must be given a semi-sitting position, unfasten tight clothes, and also calm down.
3. The patient needs to be warmed by wrapping the lower limbs in a blanket.
4. Open a window to provide the sick person with access to fresh air.
5. Under the control of measuring blood pressure, give the patient antihypertensive drugs.

Diuretic drugs, such as lasix or furosemide, are given intravenously to lower blood pressure. They remove excess fluid, which reduces swelling of brain tissue. Clonidine is also used parenterally.

Nefidipine tablets are taken under the tongue. With apnea attacks, aminofillin is administered. For convulsions, two drugs are prescribed: Relanium or Sibazon.

To evaluate the effectiveness of treatment, attention is paid to improving the patient's well-being. The main thing to remember is that it is forbidden to sharply reduce the pressure. After emergency drug therapy, food should not be eaten for a few more hours.

Conclusion

As you know, cardiac pathology can be one of the causes leading to death. Psychosomatics is characteristic for such CVS diseases as hypertension, coronary artery disease (ischemic disease), arrhythmia. Physicians are increasingly recognizing the link between psychosocial and somatic factors. These include malnutrition, stress, bad habits.

It is very difficult to eliminate hypertension and its psychosomatic causes on your own, so you need to seek help not only from a therapist, but also from a qualified psychologist.

According to official statistics, the number of patients diagnosed with hypertension is increasing every year. Moreover, 30 percent of them have already experienced a hypertensive crisis.

Knowledge about the nature and methods of treatment of the disease is necessary not only for patients suffering from this disease, but also for people who are not susceptible to hypertension. This information can help them relieve the exacerbation of the disease in relatives and friends, as well as alleviate their condition during and after a hypertensive crisis.

General information

The very phenomenon of a hypertensive crisis is an emergency condition characterized by a sharp jump in blood pressure and accompanied by a significant violation of the blood circulation of individual organs.

Which in turn significantly worsens the risk of cardiovascular diseases such as stroke, myocardial infarction, aortic aneurysm dissection, acute renal and heart failure.

Interesting! It is worth noting that there is no single value, after which there is a hypertensive crisis and treatment is required. This condition is always individual and often only the doctor understands when to start treating this condition.

So, for example, for one patient, whose normal pressure is 130/90, a jump to 150/100 is accompanied by a sharp deterioration in health and is a crisis of hypertension. For another person, such pressure is a variant of the norm.

Causes

The causes of a hypertensive attack are ambiguous. In a hypertensive crisis, two types are taken into account - endogenous and exogenous.

Endogenous factors include those that occur within the body. Thus, heredity and predisposition to the disease can be an endogenous factor.

Another "internal" cause that causes an attack can be diabetes mellitus, kidney failure, hormonal disorders, atherosclerosis, pheochromocytoma and many other diseases, the treatment of which is not always possible.

Age is also an endogenous factor. Despite the fact that the disease can also develop in young people, the main risk group is people after 35-40 years of age. And women are at greater risk.

As you probably guessed, exogenous causes include external stimuli:

1. Physical and emotional overload. One of the common causes of a hypertensive crisis (and often in the younger generation) are various body overloads that cause dizziness and other manifestations of weakness. These include chronic lack of sleep, stress, excessive exercise, overwork.

1. Weather conditions. Changes in weather, climate change, air travel can also affect the development of the disease.

1. Bad habits. No less impetus to the development of the disease is given by bad habits of people. Such as smoking, alcohol abuse, an excess of salt in food, addiction to caffeine.

1. withdrawal syndrome. Often, a hypertensive crisis can develop after discontinuation of drugs that reduce blood pressure. Basically, this effect leads to the abolition of ß-blockers and clonidine.

Classification

To ensure the best prognosis and treatment of the disease, it is not enough to know the causes of the attack. It is necessary to understand the types of hypertensive crisis. Based on the characteristics of the increase in blood pressure, hyperkinetic, hypokinetic and eukinetic crises are distinguished.

hyperkinetic crisis

Hyperkinetic hypertensive crisis is manifested after a sharp release of adrenaline into the blood.

It is characterized by a rather sharp increase in systolic ("upper") pressure with a relatively smooth and slight increase in diastolic ("lower") pressure.

A hyperkinetic attack is possible mainly in the early stages of hypertension. Accordingly, its manifestation is not preceded by a preliminary deterioration in well-being.

In a hypertensive crisis of this type, the main complaints of the patient are manifested in a sharp headache, possibly throbbing.

There is also a general excitation of the body, anxiety, trembling and fever appear. A hyperkinetic crisis is also accompanied by a rapid heartbeat, increased sweating, and the appearance of spots on the skin.

Often, patients complain of dizziness, visual turbidity ("flies", "snowflakes", etc.), as well as nausea, and sometimes vomiting.

Such an attack lasts from a couple of minutes to several hours and does not cause serious consequences for the body.

Hypokinetic crisis

Unlike hyperkinetic, hypokinetic crisis is characteristic of people suffering from advanced stages of hypertension.

It is accompanied by a sharp increase in diastolic pressure. Systolic pressure also rises, but not significantly. The pulse remains at a normal level or decreases, causing bradycardia.

Important! The hypokinetic crisis has a longer character, it can last from a couple of hours to 5 days.

Due to the fact that this crisis is of an extended nature, the symptoms are on the rise. The main ones are: headache, dizziness, nausea, lethargy and lethargy, hearing and vision impairment.

An electrocardiogram made during a hypertensive crisis of this nature will show dangerous changes in the work of the heart muscle. Due to the long-term nature of such a crisis, it is dangerous for the development of serious complications up to a heart attack or ischemic stroke.

eukinetic crisis

The eukinetic crisis is characterized by a simultaneous increase in both systolic and diastolic pressure. It can manifest itself in people at II-III stages of hypertension.

The symptoms of a hypertensive crisis of a eukinetic nature are similar to those of a hyperkinetic crisis. Headache and dizziness are quite common with this type of crisis. The symptoms develop just as quickly, but are not as troublesome.

Complicated and uncomplicated crisis

In addition to the classification described above, the concept of hypertensive crisis is divided into complicated and uncomplicated crisis. Such a division occurs depending on whether any target organ was affected during a hypertensive attack or not.

Uncomplicated hypertensive crisis can appear at an early stage of the disease. In this type of crisis, the pressure rises sharply, but without signs of organ damage.

A possible course of an uncomplicated crisis may be a temporary obstruction of the normal blood flow to the brain, a hormonal disorder, as well as a number of neurovascular disorders.

Complicated hypertensive crisis manifests itself in the late stages of hypertension. A typical manifestation of a complicated crisis is cardiovascular pathology, the most common of which is hypertensive encephalopathy.

Such a hypertensive attack is terrible due to complications such as stroke, Parkinson's disease, and a decrease in intellectual activity.

The course of a complicated hypertensive crisis is slow and can last for several days. The first signals of such an attack are drowsiness, ringing in the ears, heaviness in the head.

In a hypertensive crisis of a complicated type, headache, nausea, vomiting, dizziness, pain in the heart area are also observed.

Important! Complicated crises are a pronounced threat to the life and health of the patient. Treatment should be started as soon as possible, and the pressure of patients with such crises requires immediate reduction.

To stop crises of various types, there are different drugs, only a doctor can choose them correctly.

Hypertensive crisis symptoms

Symptoms of hypertensive crises are diverse and not always the same. However, the general list of symptoms, after which an attack may occur, is as follows:

• headache;
• cardiopalmus;
• internal anxiety;
• dizziness;
• nervous excitement;
• internal chills;
• lack of oxygen;
• visual impairment;
• redness on the skin.

The symptoms listed above against the background of an increase in blood pressure will help to recognize a hypertensive crisis in time, and, therefore, make a correct prognosis and minimize complications after an attack.

Emergency care for hypertensive crisis

As mentioned earlier, it is not uncommon for a hypertensive crisis to develop against a background of normal or even good general health, which was not preceded by the treatment of hypertension.

That is why it is so important to recognize the disease in a timely manner and take all necessary measures to minimize its consequences.

It is critically important to take the necessary measures at the first sign of an attack, which can even be signaled by dizziness.

While waiting for the doctor, the patient must be helped to lie down in bed in a semi-sitting position. This will help to avoid signs of suffocation or reduce their intensity.

A frequent symptom of a crisis is trembling and chills, so the patient should be covered with a blanket and warm. At the same time, do not forget about the need for fresh air.

While waiting for the doctor, you should try to reduce the pressure of the patient. At the same time, the decrease should not be sharp (this can increase dizziness) - by about 25-30 mm Hg. 1 hour from the start.

For this purpose, it is important to have the following drugs in your home medicine cabinet:

• Kapoten or Corinfar (when the upper pressure is about 200 mm Hg).
• Also, with a hypertensive crisis, it is also possible to use Clonidine sublingually.

Important! The use of these drugs is recommended for patients with already diagnosed hypertension. Moreover, the doses of the necessary medications should be discussed with the attending physician in advance.

Patients with an undiagnosed diagnosis should take these drugs with caution when the patient's condition is of great concern.

Calling an ambulance team and a competent presentation of symptoms will help reduce the damage from an attack and ensure timely treatment.

Treatment of a hypertensive crisis

After assessing the patient's condition, ambulance doctors begin to relieve the crisis - this is the first and main stage of assistance.

Crisis medications:

• In simple cases, it may be enough to take Captopril (1-2 pieces per tongue).
• In the absence of a therapeutic effect, more serious drugs are used, including centrally acting antihypertensive drugs, ACE inhibitors, vasodilators and adrenoblockers. The most common among them are: Phentolamine, Labetalol, Enalapril, Diazoxide, Sodium nitroprusside, Clonidine and Nifedipine.

These drugs can be used both individually and in combination with each other, as well as other antihypertensive drugs.

Important! All drugs contain a number of side effects, which may include dizziness, increased fatigue, hormonal disruptions, and many others. Therefore, the choice of drugs is made by the doctor, taking into account the overall picture of the patient's condition.

Depending on the severity of the attack, the patient may be given home care or recommended hospitalization. If the hypertensive crisis was easily stopped and did not cause complications, the attending physician prescribes further prognosis and treatment.

If the situation is more complicated, adequate treatment will be offered in the hospital after admission.

What is dangerous hypertensive crisis?

The consequences of a hypertensive crisis can be frightening. Often these are irreversible changes in the functioning of internal organs and body systems that affect the patient's future life.

To preserve the normal functioning of the patient, almost immediately after the attack, the following measures must be taken:

1. Undergo an examination of the body to identify the causes of jumps in blood pressure. Examination is necessary not only for patients with an undiagnosed diagnosis, but also for patients with experience. Periodic checks are needed to track disease stages, treat comorbidities, and, if necessary, adjust medical management of the crisis.
2. Keep a journal to record pressure readings. Regardless of how you feel, measuring your blood pressure 2-3 times a day should become a habit.
3. Monitor prescribed medications. Remember! It is necessary to take the prescribed drugs, even if you do not have hypertension. It is the drugs that inhibit the manifestations of the disease, and the unauthorized cancellation of their intake can lead to a deterioration in well-being and new attacks.
4. It is vital for patients with hypertension to review their diet. Keep track of calories in and out. Eliminate (in extreme cases, minimize) the consumption of table salt due to its sodium content. Include more foods containing polyunsaturated acids, calcium, magnesium and potassium in the diet. Give up bad habits such as alcohol and cigarettes. If the heartbeat is disturbed, forget about strong tea and coffee. They can be replaced with a chicory drink.
5. Review your lifestyle. If possible, reduce the number of stressful situations, observe sleep patterns and do not overload the body.
6. Adjust the amount of fluid you drink. High blood pressure should limit fluid intake to 1.5 liters per day.
7. Do not self-medicate. It is extremely important not to prescribe medications on your own or on the recommendation of friends. Also, do not change the dose of the substances taken “according to personal feelings” (weakness, dizziness, etc.) without consulting a doctor. Each case of a hypertensive crisis is unique in its own way, and only a specialist can correct the intake of medicines.

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

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 first type lies more often a psycho-emotional factor, therefore, they develop without visible organic prerequisites in stages I or II 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 pulsating in nature, flickering "flies", a grid, a veil before the eyes, doubling, 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, stabbing pains in the region of the heart, a feeling of lack of air are also characteristic.

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 second type are observed in patients with hypertension stage III and less often stage IIB. 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 severe symptom complex and a high initial level. blood pressure.

The skin is cold and dry, in places there is an asymmetry in skin temperature. Signs of cerebral disorders are expressed 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, in connection with which 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.

Hypertensive crisis develops quickly and often unexpectedly, although, usually, before this, the person's state of health is satisfactory. It often happens that a patient with hypertension (AH) during treatment begins to feel so good that he stops taking drugs, medicines or breaks the diet.

Common causes of hypertensive crisis:

- Cancellation of the drug to reduce blood pressure, dosage reduction, its replacement;
- consumption of large amounts of salty foods;
- a large amount of liquid drunk;
- excessive smoking;
- psycho-emotional overstrain;
- a long break in eating, overeating;
- hangover syndrome.

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 should 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 2-4 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 by 20-30 mm Hg. Art. compared to the original. important to give diuretic, but you must first know which drug is allowed, because. with some concomitant diseases, some drugs are contraindicated. For instance, in 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 perhaps an individual approach is needed depending on concomitant chronic diseases that limit the list of drugs taken in hypertensive crises.

This is a clinical syndrome characterized by a sudden increase in blood pressure and is accompanied by the appearance or aggravation of cerebral, cardiac symptoms against the background of autonomic and humoral disorders. Pathology can develop with any degree of 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 of 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 blood pressure;
• 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 proposed a clinical classification of 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.

Complicated hypertensive crises: the nature of the complication	Uncomplicated hypertensive crises
myocardial infarction	Cerebral uncomplicated crisis
Stroke	Hypothalamic paroxysm (diencephalic-vegetative crisis)
Acute dissecting aortic aneurysm	Cardiac uncomplicated crisis
Acute LV failure	Increase in blood pressure up to 240 mm Hg. Art.. or ADD up to 140 mm Hg.
Unstable angina	Significant increase in blood pressure in the early postoperative period
Arrhythmias (paroxysms of tachycardia, atrial tachyarrhythmia, high-grade ventricular extrasystole)
Transient ischemic attack
Eclampsia
Acute hypertensive encephalopathy
Bleeding
Acute renal failure

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 must be reduced gradually, 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

A drug	Dose and route of administration	Possible complications, side effects
Dibazol	4-8 ml 1% solution in/in. diluted in 1O ml of physiological solution
Obzidan	3-5 ml of 0.1% p-pa IV slowly, diluted in 20 ml of physiological solution	A sharp drop in blood pressure. bradycardia, AV block
Labetalol	200 mg diluted in 250 ml 5% p-pa glucose. IV drip at a rate of 2 mg/min	Bradycardia
Clonidine	0.1-0.2 mg IV slowly over 3-5 minutes	Sedation
Cormagnesin	20 ml IV over 7 minutes	Bradycardia
Sodium nitroprusside	50-100 mg, diluted in 250-500 ml of 5% p-pa glucose, IV drip	Hypotension, nausea, tremor, increased uric acid
Hydrolasin	25 mg diluted in 500 ml saline. IV at a rate of 20-30 drops per minute	Hypotension
Nimodipine	IV drip: 15 mcg/kg at 1 hour, then ZO mcg/kg at 1 hour	Tachycardia, hypotension, phlebitis at the injection site
Furosemide	40-200 mg IV bolus	Hypokalemia. convulsions

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 Medicines 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.

The second possible reason is 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.

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 for 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 correctly 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. After that, the patient will be referred for inpatient treatment, designed to lower 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 the 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 a water-salt crisis at the 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 the abdominal cavity and lower extremities. 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 condition 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 there may be another rapid rise, 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 overstrain, excessive consumption of 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.

Sympathetic-adrenaline 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 becomes particularly pale, body tremors, tremors of the extremities are 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 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 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 severity of the 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 the susceptibility and motor activity of the lower extremities, face and tongue.

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 in 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 ​​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 of the therapeutic effect within half an hour, the reception is repeated. 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 needs to take all the 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 distinguished. 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. When providing emergency care, 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 insufficiently effective treatment or a violation of the 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 a 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, 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 (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 of diabetes mellitus appears). 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), hemoglobin level 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 feature 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 of the gastrointestinal tract and changes in the nervous system in the form of funicular myelosis.

Hemolytic anemia 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, stabbing pains in the region of the heart, a feeling of lack of air are also characteristic.

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, 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 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 should 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 perhaps an individual approach is needed depending on 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 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 to 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, a convulsive state with loss of consciousness may occur.

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.

The ECG shows depression of the S-T segment. 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. The pain syndrome 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 the necessary treatment will begin, and, therefore, 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. Possible consequences include 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 exertion. 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 successfully copes with the provision of blood circulation even with high blood pressure.

In such a hypertensive state, emergency care corresponds to the activities carried out in 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;
• fatal outcome.

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.

Every year in Russia there are from 5 to 10 million calls to the ambulance for high blood 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.