Hypertensive crisis

The hypertensive crisis (English: hypertensive crisis ) is a sudden dysregulation of blood pressure in the systemic circulation . It is associated with high blood pressure and has a good short-term prognosis. The European Society of Hypertension and the European Society of Cardiology define the hypertensive crisis with blood pressure values> 180/120 mmHg. It is an emergency medical indication .

Definition of terms and differential diagnosis

Hypertensive derailment is the generic term for crisis-ridden high blood pressure values, with or without further symptoms.

One speaks of a hypertensive crisis when there is no evidence of acute hypertensive organ damage in the case of critically increased arterial blood pressure. Signs of acute organ damage can be neurological deficits, shortness of breath or chest pain.

Get in connection with the increase in blood pressure signs of organ damage to, it is a hypertensive emergency (English: hypertensive emergency ).

trigger

The hypertensive crisis is most frequently triggered because antihypertensive drugs have not been taken as prescribed (see adherence ). Emotional excitement, anxiety disorders or panic attacks are other causes of high blood pressure. Rarer causes are increasing narrowing of the renal arteries , acute kidney disease or a DD genotype of the angiotensin converting enzyme . Likewise, the consumption of food rich in tyramine (wine, beer, cheese, sauerkraut) with simultaneous intake of antidepressants from the class of MAO inhibitors . By inhibiting monoamine oxidases (MAO), biogenic amines (e.g. the sympathomimetic tyramine) are degraded more poorly.

Symptoms and Treatment Strategy

Those affected often have headaches, dizziness, nosebleeds or tremors all over their bodies, but they can also be symptom-free. Since the symptoms are not life-threatening, it is sufficient (after appropriate exclusion diagnosis) to gradually lower the blood pressure to normal values. For this purpose, medication can be administered orally and the patient can initially be cared for on an outpatient basis. A hypertensive crisis is dangerous with the corresponding previous illnesses, since it can develop relatively quickly into a hypertensive emergency, which is always associated with severe disorders of various organs, such as B. clouding of consciousness, heart failure, stroke and other organ damage.

Medication

The lowering of blood pressure should be done slowly. The systolic pressure should be reduced by a maximum of around a quarter in the first two hours of treatment. For the treatment of hypertensive emergencies, nitrendipine is available as an oral solution. Urapidil and clonidine can be administered through a venous line. In addition, the administration of a loop diuretic can be considered. The often observed use of nitroglycerin in the case of a pure blood pressure crisis (without angina pectoris ) takes place as off-label use outside of the approval within the scope of the medical freedom of therapy.

Experienced patients, especially in whom this disease is hereditary and therefore increased blood pressure more or less regularly, often carry Urapidil as capsules with them in emergencies .

Individual evidence

1. ↑ JD Blumenfeld, JH Laragh: Management of hypertensive crises: the scientific basis for treatment decisions. In: American journal of hypertension , Volume 14, Number 11 Pt 1, November 2001, pp. 1154-1167, ISSN  0895-7061 . PMID 11724216 . (Review).
2. ↑ G. Mancia, R. Fagard et al .: 2013 ESH / ESC Guidelines for the management of arterial hypertension In: European Heart Journal , 2013, 34, p. 2206, doi: 10.1093 / eurheartj / eht151
3. ^ Jens Kuhn: Symptom headache. Schattauer Verlag, 2008, ISBN 978-3-7945-2476-1 , p. 82. Restricted preview in the Google book search
4. ↑ Herold Gerd: Internal Medicine. 2007, p. 268.
5. ↑ Drug treatment of hypertensive crises . ( Memento of December 14, 2010 in the Internet Archive ; PDF) In: medicalforum.ch

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