Hypertensive emergency
The hypertensive crisis (English: hypertensive urgency ) is a sudden dysregulation of blood pressure in the systemic circulation. She goes with a high blood pressure accompanied, usually greater than 230/120 mmHg, and has a good prognosis in the short term. It is an emergency medical indication.
Definition and differential diagnosis
Hypertensive derailment is the generic term for a crisis elevated blood pressure values , with or without other symptoms. From a hypertensive crisis is called when in critically elevated arterial blood pressure no evidence of acute hypertensive organ damage is present. Signs of acute organ damage may be neurological problems, shortness of breath or chest pain. Stepping in connection with the increase in blood pressure signs of organ damage on it is a hypertensive emergency (English: hypertensive emergency ).
Trigger
The most common hypertensive crisis is triggered, because antihypertensive drugs have not been taken as prescribed (see adherence ). Emotional arousal, anxiety disorders or panic attacks are additional causes of increases in blood pressure. Less common causes include increasing narrowing of the renal arteries, acute kidney disease or a DD genotype of the angiotensin-converting enzyme. Also, the taking tyraminreicher food (wine, beer, cheese, sauerkraut ) with concurrent use of antidepressants from the class of MAO inhibitors. By inhibition of monoamine oxidases ( MAO), biogenic amines (e.g., acting sympathomimetic tyramine ) degraded worse.
Symptoms and Treatment Strategy
Sufferers often have headaches, dizziness, nose bleeds or trembling all over the body, but can also be symptom free. Since the symptoms are not life threatening, it is sufficient (after proper diagnosis by exclusion ), the blood pressure gradually decrease to normal values . For this purpose, drugs can be administered orally and the patients initially closely outpatient basis are cared for. Dangerous is a hypertensive crisis with appropriate pre-existing conditions, as it may relatively quickly become a hypertensive emergency, which is always accompanied by serious disturbances of various organs, such as clouding of consciousness, heart failure, stroke, and other organ damage.
Drug treatment
The blood pressure lowering should be done slowly. The systolic pressure should be lowered by a maximum of about a quarter in the first two hours of treatment. For the treatment of nitroglycerin are available as a spray or bitable capsule. About a venous access urapidil and clonidine may be administered. In addition, the administration of a loop diuretic may be considered.
Experienced patients, especially where this disease is hereditary and very high blood pressure therefore occurs more or less regularly carry for emergencies often urapidil and nitroglycerin ( spray or capsules ) with itself.
Swell
- Disease in cardiology
- Disease in emergency medicine