Does your blood pressure suddenly skyrocket? Let's talk about Hypertensive Crisis!

Have you ever wondered what would happen if your blood pressure, or "pressure" as we all know it, suddenly went too high? Sometimes you might feel dizzy or have a feeling of something strange in your chest. This is the condition we are going to talk about today, called hypertensive crisis. This is a serious condition, so it is very important that we know exactly what to do about it.

What is a hypertensive crisis? Let's find out exactly!

Simply put, a hypertensive crisis is when your blood pressure suddenly becomes very, very high. Now you might be asking, "What should your normal blood pressure be?" Let's see.

The normal blood pressure of a healthy person should be as follows:

• The upper number (systolic pressure) : should be less than 120 millimeters of mercury (mm Hg).
• Lower value (diastolic pressure) : Should be less than 80 millimeters of mercury (mm Hg).

However, during a ``Hypertensive Crisis'' these numbers increase unimaginably:

• Upper limit : 180 mm Hg or higher, and/or
• Lower value : 120 mm Hg or higher.

This is something to remember: High blood pressure is a medical emergency. This means that if your blood pressure reaches these levels, you should go to a hospital emergency room immediately.

Most often, this type of emergency occurs in people who suffer from high blood pressure (hypertension). This means that their blood pressure is constantly higher than normal. According to experts, between 1% and 2% of people with high blood pressure can experience a ``Hypertensive Crisis''. But, surprisingly, this condition can occur even in someone who has never had a blood pressure problem before.

There are two main types of this, right? What are they?

Yes, there are two main types of this `(Hypertensive Crisis)`. Let's talk about that in a little more detail .

1. Hypertensive Urgency:

This is when your blood pressure rises too high, to the previously mentioned 180/120 mm Hg or higher. But, most importantly, there is no damage to your internal organs. Some doctors call this ``uncontrolled hypertension'' instead of ``Hypertensive Urgency''. So, whatever the name, the main thing here is to quickly bring your pressure back to a healthy level.

2. Hypertensive Emergency:

This is the most dangerous type. Your blood pressure also goes up a lot, but it also causes new damage to your body's organs, or worsens existing damage.Just think, this can damage vital organs like your heart, aorta, eyes, brain, and kidneys. Even conditions like severe preeclampsia and eclampsia that occur in pregnant mothers fall into this category of ``Hypertensive Emergency''.

You may have heard the term "Malignant Hypertension." It's actually an old term that was used in the early 20th century. It meant a sudden, severe increase in blood pressure that caused damage to the kidneys and eyes. Some doctors still use the term "Hypertensive Emergency" when talking about a "Hypertensive Emergency." However, doctors today prefer to use the term "Hypertensive Emergency" because it has a more specific definition today.

What are the possible symptoms? How do you recognize it?

The symptoms of a ``Hypertensive Crisis'' depend on whether or not the organs have been damaged, as mentioned earlier.

Hypertensive Urgency (meaning, when the pressure is too high without organ damage) often does not cause any symptoms. The only way to know if your blood pressure is too high is to have it measured. However, sometimes there may be symptoms such as:

• Feeling uneasy and fearful (Anxiety)
• A slight headache.
• Bleeding from the nose
• Slight difficulty breathing

The symptoms of a hypertensive emergency (that is, when the pressure causes organ damage) are more severe and include:

• Change in mental status (anxiety, confusion)
• Chest pain
• Dizziness (vertigo)
• Swelling of the body (Edema)
• Heart palpitations
• Less urine output than normal
• Convulsions (convulsive state, similar to a fit)
• A severe headache.
• Symptoms of paralysis (for example, sudden drooping of one side of the face, difficulty speaking, sudden weakness in the arms and/or legs)
• Vision changes (such as eye pain, vision loss, sudden blurred vision)

When a doctor examines you, you may see symptoms like these in a ``Hypertensive Emergency'':

• Jugular venous distention
• Crackling sounds when listening to the lungs
• Abnormal heart sounds that were not present before (heart murmurs)
• Signs of damage to the blood vessels at the back of the eye
• Unusual, asymmetrical weakness that is suspicious of a paralytic condition

Why does this situation occur? What are the reasons?

There can be several reasons why a ``Hypertensive Crisis`` like this can occur. Let's look at the main ones:

• The most common reason is that you are not taking your blood pressure medication properly and as prescribed. If you miss your dose for any reason, you run the risk of this happening.
• Suddenly stopping medication used for blood pressure.
• Medicines interacting with other medications you are taking.
• Kidney disease.
• Endocrine issues.
• Preeclampsia or eclampsia during pregnancy.
• Use of some addictive drugs.
• Head trauma (injury to the head).
• Brain tumor.
• Some medications you take for other conditions.

Some of the medications that can cause a ``Hypertensive Crisis'' are:

• Types of Steroids
• Some medicines for depression
• Cyclosporine
• Pseudoephedrine, which is found in some cold and flu medications

Who is at higher risk? (Risk Factors)

Some people are more at risk of having a ``Hypertensive Crisis'' than others. Let's see who they are:

• For those with obesity.
• For men.
• For black people (this may be based on genetic and socioeconomic factors).
• The medicine given for blood pressure is right for those who don't use it consistently.
• For those who use stimulant drugs without a doctor's prescription.

What dangerous complications can this cause?

If the pressure rises to this dangerous level, it can cause serious complications. These include:

• Sudden, rapid weakening of heart function (acute heart failure).
• Sudden accumulation of fluid in the lungs (acute pulmonary edema).
• Sudden loss of kidney function (acute kidney failure).
• Aortic dissection is a tear in the largest blood vessel in your body, the aorta.
• Bleeding inside the brain (intracranial hemorrhage).
• A heart attack is caused by reduced blood flow to the heart.
• A stroke caused by reduced blood flow to the brain (`ischemic stroke`).
• Temporary impairment of brain function (`hypertensive encephalopathy`).

Think about how serious all of this is. That's why it's important to keep your blood pressure under control and seek treatment quickly if a ``Hypertensive Crisis'' occurs.

How do doctors diagnose this accurately?

A doctor will first measure your blood pressure in both arms. Then, they will ask about your medical history, talk about your symptoms, and do a physical exam. They may also need to do some tests to help find the cause of your condition.

There are several types of tests that can be done:

• Blood tests
• Urine tests
• Electrocardiogram (EKG/ECG) test that records the heart rate
• Fundoscopic examination (examination of the inside of the eye)
• Neurological exam
• Ultrasound of the heart (Transthoracic echocardiogram)
• A ``Computed Tomography (CT) scan`` of the chest and head

If you have signs of new organ damage, your doctor will diagnose you as having a ``Hypertensive Emergency''. If there are no such signs, it will be diagnosed as a ``Hypertensive Urgency''.

How is it treated? Can it be cured quickly?

A ``Hypertensive Crisis'' is treated in a hospital emergency room. Doctors will give you medication and bring your blood pressure down to a safe level.

• If there is no organ damage (in case of `Hypertensive Urgency`): You will be able to go home the same day (with medication to take at home).
• But, if you have a ``Hypertensive Emergency``: You will need to stay in the hospital's intensive care unit (ICU) for a few days. There, doctors will give you medication directly into a vein (an ``IV - intravenous`` method). They will also monitor your blood pressure continuously.

Your medical team will decide how quickly to lower your blood pressure, taking into account the other medical conditions you have. In some cases, lowering your blood pressure too quickly can cause your organs and tissues to not get enough blood. So, doctors may lower your blood pressure gradually, over a period of 24 to 48 hours.

However, if you have conditions like aortic dissection, severe preeclampsia, or eclampsia, doctors will lower your blood pressure quickly during a hypertensive crisis. In such cases, the benefits of lowering your blood pressure quickly far outweigh the small risks.

Medications given for treatment

Here are some of the medications that are given to treat a ``Hypertensive Crisis``:

• `Captopril`
• `Clevidipine`
• `Clonidine`
• `Esmolol`
• `Hydralazine`
• `Labetalol`
• `Nicardipine`
• `Nifedipine`
• `Nitroglycerin`
• `Nitroprusside`

Doctors will choose the medicine that best suits your needs. They will also consider your other medical conditions and the other medications you are taking. So, don't panic when you see these medicines, it is the doctor/lady who will decide what is best for you.

When should I see a doctor?

If your blood pressure is 180/120 mm Hg or higher, call 911 (1990 Suwaseriya Ambulance Service in Sri Lanka) immediately, or go to the emergency room of the nearest hospital. You need urgent treatment!

After you have been treated for a ``Hypertensive Crisis'', see your regular doctor. He or she may decide to ``adjust'' your blood pressure medication. He or she will also talk to you about any changes you need to make in your daily life.

For example, you may be advised to change what you eat (follow a diet like the DASH diet) or add more exercise to your routine.

Will this happen to me again? What should I know?

A ``Hypertensive Crisis'' is a warning sign that your blood pressure is not at the right level. Your doctor can help you lower your blood pressure and keep it at a healthy level. The most important thing is to keep your follow-up appointments and take your medications exactly as your doctor tells you to.

It's normal for anyone to feel scared when they hear the word "Crisis." You may think, "Oh, will my blood pressure go up like this again?" When you receive a diagnosis of a ``Hypertensive Crisis,'' you may also wonder how it will affect your health and future.

But remember, there could be many reasons why your blood pressure could be this high. Doctors are trained to identify the causes that are unique to each person. Once you know the cause, you can take steps to reduce your risk of it happening again.

This may include setting reminders to take your medication. Or, it may mean talking to your doctor about medications you take for other reasons and adjusting them. Every step you take to control your blood pressure now will help protect you from serious problems in the future.

The most important things we need to remember from this (Take-Home Message)

Okay, so, shall we remind you again of the most important things we've talked about that you need to keep in mind?

• A hypertensive crisis is when your blood pressure rises to 180/120 mm Hg or higher. This is a medical emergency.
• There are two types of this: `Hypertensive Urgency` without organ damage and `Hypertensive Emergency` with organ damage.
• Symptoms vary. Sometimes there may be no symptoms at all, or they may include severe headaches, chest pain, and blurred vision.
• The main reason is not taking the medication prescribed for blood pressure properly. Kidney disease and certain medications can also cause this.
• If the pressure is 180/120 mm Hg or higher, go to a hospital immediately.
• Treatment includes medication to lower blood pressure. You may also need to stay in the hospital.
• To prevent this from happening again, follow your doctor's instructions carefully, take your medication properly, and make the necessary lifestyle changes.

Finally, take care of your blood pressure. Check it regularly. Because, to live a healthy life, it is very important for us all to be aware of this "silent killer". If you have any more questions, don't be afraid to ask your doctor or midwife. They will help you!

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