Hypertension emergencies and urgency that need to be watched out for & bull; hello healthy

High blood pressure or hypertension is a chronic condition that cannot be cured, but needs to be controlled. If allowed, blood pressure can increase. This can increase the risk of hypertension complications. In medical terms, this condition is known as a hypertensive crisis, which consists of hypertensive urgency and emergency. Then, what is meant by these three things?

Definition of hypertensive crisis, hypertension urgency and emergency

Hypertensive crisis is a type of hypertension that occurs when blood pressure rises very high and occurs suddenly. Hypertensive crisis consists of hypertensive urgency and hypertensive emergencies. A person is said to have a hypertensive crisis when his blood pressure reaches 180/120 mmHg or more.

For information, a person is classified as hypertensive if their blood pressure reaches 140/90 mmHg or more, while normal blood pressure is below 120/80 mmHg. If the blood pressure is between normal and hypertension, you are classified as prehypertension.

Hypertensive crisis is indeed a rare condition. Of the approximately 110 million emergency hospital visits associated with hypertension, only 0.5 percent are associated with a hypertensive crisis.

Although rare, this condition should still receive attention. The reason is, the hypertension crisis is an emergency condition, which has the potential to cause other serious health problems.

There are two types of hypertensive crises, namely hypertensive urgency and hypertensive emergencies. The following is a further explanation.

• Hypertension urgency

One of the hypertensive crises is urgency hypertension. Urge hypertension is a type of hypertensive crisis that occurs when your blood pressure is very high that it reaches 180/120 mmHg or more, but there is no damage to your organs.

This type of urgency hypertension can generally be controlled with oral high blood pressure medication from a doctor. Your increased blood pressure can be lowered within a few hours by taking this medicine.

However, urgency hypertension is also a condition that must be worried about. The reason is, as reported in the Journal of Hospital Medicine, patients with urgent hypertension are at risk of experiencing organ damage in the next few hours, if not treated immediately. This condition can also increase morbidity (morbidity) and mortality (mortality) in the long term.

• Emergency hypertension

Similar to urgency hypertension, hypertensive emergencies occurs when the blood pressure reaches 180/120 mmHg or higher. However, this condition has caused damage to your organs, such as the brain, heart, or kidneys, which can lead to various complications of the disease.

Some of the complications that may occur from organ damage related to emergency hypertension, namely pulmonary edema, angina, eclampsia in pregnant women, kidney failure, stroke, heart attack, heart failure, eye damage, and acute aortic dissection.

Therefore, someone who has hypertensive emergency needs to get emergency medical treatment immediately. Generally, patients with this type of hypertension will be given blood pressure-lowering drugs through an IV. With proper treatment, patients have a great chance of recovering and blood pressure back to normal.

What are the signs and symptoms of a hypertensive crisis?

Generally, high blood pressure usually doesn't show any signs or symptoms of hypertension. However, in patients with hypertensive crisis, especially hypertensive emergencies, some symptoms can be felt. As for urgency hypertension patients generally do not feel any significant symptoms.

Some of the signs and symptoms of an emergency hypertensive crisis that may arise are:

• Chest pain.
• Hard to breathe.
• Back pain.
• Weakened body.
• Severe headache
• Blurry vision.
• Back pain.
• Nosebleeds (epistaxis).
• Decrease in consciousness, even fainting.
• Severe anxiety.
• Nausea and vomiting.
• Seizures.

There may be other signs and symptoms not listed above. If you have concerns about certain symptoms, consult a doctor immediately.

When to see a doctor?

If you experience the symptoms mentioned above, you should immediately go to the hospital. The reason is, these symptoms are dangerous to your health and potentially life threatening. You may also need intensive care in the hospital if this hypertensive crisis occurs.

However, you need to remember, each sufferer's body shows signs and symptoms that vary. In order for you to get the most appropriate treatment and according to your health condition, get any symptoms checked by the doctor or the nearest health service center.

What are the causes of hypertensive emergency and urgency?

Hypertensive crisis, both emergency and urgency, generally occurs in someone who already has a history of hypertension, be it primary hypertension or secondary hypertension. This condition can occur when hypertensive patients experience a persistent or continuous increase in blood pressure for years, until their blood pressure reaches a crisis level.

This condition usually occurs when you can't control blood pressure properly. For example, continuing to do things that are taboo for people with hypertension or not taking hypertension drugs in accordance with the dosage and the provisions given by the doctor.

In addition, consumption of certain drugs can also raise your blood pressure higher, such as pain relievers (NSAIDs), decongestants, or birth control pills, as well as illegal drugs such as cocaine and methamphetamine. These drugs can also interact with some high blood pressure medications, making them dangerous for your body when taken at the same time.

Apart from that, certain medical conditions can also be the cause of this hypertensive crisis or emergency. Several conditions can cause blood pressure to rise, such as:

• Stroke
• Adrenal gland tumor
• Stress
• Postoperative trauma
• Heart attack
• Heart failure
• Kidney failure
• Head trauma
• Spinal cord syndrome
• Damage to the aorta
• Preeclampsia

How can hypertensive emergencies cause organ damage?

Very high blood pressure can interfere with blood flow in the blood vessels. When the process of blood flow is disrupted, endothelial cells that play a role in dilating and narrowing blood vessels become disrupted.

When the endothelium is affected, the structure of the blood vessel walls is damaged, making it prone to causing inflammation. When this happens, blood vessels can leak and fluid or blood in them can leak out.

As a result, the heart cannot pump blood effectively and the supply of nutrients to other important organs is limited. In this condition, the function of the body organs becomes disturbed so that it is damaged.

How do doctors diagnose a hypertensive crisis?

To diagnose a hypertensive crisis, both emergency and urgency, the first thing the doctor does is measure blood pressure. As previously mentioned, you are classified as having a hypertensive crisis if you have a blood pressure of 180/120 mmHg or more.

However, to be sure, blood pressure checks may be done several times. If the result is still the same or above that number, you should really get emergency medical care.

In addition to measuring blood pressure, there are several other tests that you may do to determine whether your hypertensive crisis is classified as an emergency and has experienced organ damage. Some of the tests that may be done, such as:

• Electrocardiogram (EKG).
• Urinalysis.
• CT Scan.
• Blood test.

How is hypertension emergency and urgency treated?

Patients with hypertension crisis, both emergency and urgency, experience a drastic increase in blood pressure. However, hypertensive emergencies and urgency crises are handled in a slightly different way.

Urge hypertension treatment

Urge hypertension patients usually do not show signs and symptoms, and do not experience organ damage. Therefore, this type of crisis patient does not require emergency medical treatment.

There is no evidence that shows that patients with hypertension with urgency have a greater chance of recovering by being treated in an emergency manner. In fact, treating hypertension too quickly that is not accompanied by symptoms has the potential to cause side effects.

Quoted from Cardiology Secrets , too quickly lowering blood pressure in hypertensive patients without symptoms can be at risk of causing health problems, such as ischemia and heart infarction. Therefore, patients with hypertension urgency should be treated gradually, by lowering blood pressure slowly over 24-48 hours.

In most cases, patients with hypertension urgency only need to undergo outpatient care, no need to be hospitalized.

Emergency hypertension treatment

This type of emergency hypertension crisis has the potential to be life threatening, so the sufferer must immediately get intensive treatment at the hospital.

In contrast to hypertensive urgency, hypertensive emergency patients must be hospitalized and receive intravenous treatment. The decrease in blood pressure is also done gradually over a period of several hours. Blood pressure that drops too quickly within 24 hours increases the risk of bleeding in the brain, and even death.

The following are the types of drugs that are usually given by the medical team to treat hypertensive emergency patients, depending on what organs are damaged and the health problems experienced by this emergency hypertension:

1. Acute aortic dissection

If this hypertensive crisis causes acute aortic dissection, the patient will be given the drug esmolol intravenously. This medicine will lower blood pressure quickly. The average patient with acute aortic dissection should immediately lower his blood pressure within 5-10 minutes.

If the blood pressure is still high after giving esmolol, the doctor will add a vasodilator drug type nitroglycerin or nitroprusside.

2. Acute pulmonary edema

Patients with acute pulmonary edema will be treated with nitroglycerin, clevidipine, or nitroprusside. With the administration of these drugs, the patient's blood pressure is expected to return to normal within 24-48 hours.

3. Myocardial infarction or angina pectoris

If the emergency high blood pressure results in myocardial infarction (heart attack) or angina pectoris, the patient will be given esmolol. In some cases, esmolol will also be combined with nitroglycerin.

The target blood pressure after administration of this medicine is below 140/90 mmHg, and patients can be discharged if the blood pressure is below 130/80 mmHg.

4. Acute renal failure

Emergency hypertension accompanied by acute renal failure can be treated with clevidipine, fenoldopam, and nicardipine. According to studies from Annals of Translational Medicine , of the 104 patients treated with nicardipine, approximately 92% experienced a significant drop in blood pressure within 30 minutes.

5. Preeclampsia and eclampsia

For pregnant women who experience preeclampsia and eclampsia, the doctor will give hydralazine, labetalol, and nicardipine. Other antihypertensive drugs, such as angiotensin-converting enzyme inhibitors , angiotensin receptor blockers , direct renin inhibitors , and sodium nitroprusside should be avoided.

6. Postoperative hypertension

If emergency hypertension occurs after the patient has undergone a surgical procedure, the doctor will give an infusion of clevidipine, esmolol, nitroglycerin, or nicardipine.

7. Tumors of the adrenal glands or use of illegal drugs

If hypertension is related to a tumor in the adrenal glands (pheochromocytoma) or due to the consumption of illegal drugs, such as cocaine and amphetamine, the doctor will give an infusion of clevidipine, nicardipine, or phentolamine.

What are the lifestyle changes that can be made to overcome the hypertensive crisis?

In addition to medical treatment, you must also make changes to your lifestyle and diet. This is important to prevent hypertensive emergencies and urgency to return at a later time.

Some positive lifestyle changes you can make to help lower high blood pressure, such as a hypertensive diet by reducing salt intake, regular exercise, and others. If you have any questions, consult your doctor for the best solution to your problem.

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