What Is Hypertensive Crisis?
A hypertensive crisis is a rapid elevation in blood pressure. In a healthy individual systolic and diastolic blood pressure measures 120 mmHg and 80 mmHg respectively. While in a person with hypertensive crisis, systolic blood pressure records 180 mmHg or higher, and diastolic blood pressure records 120 mmHg or higher. It occurs due to uncontrolled hypertension and is considered a complication. It is more common in older adults, especially males. Hypertensive crisis are found to be more prevalent in the African-American population.
There are two types of hypertensive crisis;
- Hypertensive Urgency: When the blood pressure readings reach up to or more than 180/110 mmHg but do not cause any organ damage, it is called hypertensive urgency.
- Hypertensive Emergency: When the blood pressure readings go above 180/110 mmHg causing organ damage, it is called a hypertensive emergency.
Who Is Likely to Develop Hypertensive Crisis?
Hypertensive crisis are more common in older adults, especially males. It is found to be more prevalent in the African-American population. Studies found that one to two percent of individuals with hypertension develop hypertensive crisis. Other factors are;
- Being Overweight or Obese: Being overweight and obese leads to the deposition of fat in and around the kidneys which causes the compression of kidneys which is accompanied by increased intrarenal (inside kidney) pressure and hypertension.
- Low Physical Activity: Lack of exercise or physical inactivity can make arteries stiff and narrow which causes the heart to take extra effort to pump the blood for circulation which in turn raises the blood pressure.
- Increased Intake of Food Rich in Salt: Salt contains sodium and sodium can pull water into the bloodstream. An increase in sodium causes more water and blood in the bloodstream which leads to high blood pressure.
- Smoking or Tobacco Use: Nicotine in tobacco can increase the release of epinephrine and norepinephrine. These hormones can increase blood pressure.
- Being Diabetic: Diabetic individuals are more likely to develop hypertensive crisis. High blood sugar can damage blood vessels in the kidney which may impair kidney functions.
- History of Any Heart Condition: Hypertensive heart condition occurs due to long-standing hypertension. Individuals with coronary artery disease and congestive heart failure are at high risk for developing hypertensive crisis.
What Are the Causes of Hypertensive Crisis in Older Adults?
The causes of the hypertensive crisis include:
- The most common cause is failure to take blood pressure medications or sudden stoppage.
- Taking various medications whose interactions may lead to increased blood pressure.
- Medications like steroids, antidepressants, Cyclosporine, and Pseudoephedrine may predispose to hypertensive crisis.
- Kidney diseases like glomerulonephritis, kidney stone, polycystic kidney disease, etc. are associated with high blood pressure.
- Cardiovascular conditions like stroke or heart attack
- Excessive production of aldosterone and cortisol due to any condition can cause retention of sodium and loss of potassium which leads to excessive blood pressure.
- Brain tumor or brain injury
What Are the Signs and Symptoms Associated With Hypertensive Crisis?
The signs and symptoms associated with hypertensive crisis include the following:
- Difficulty in breathing.
- Chest pain.
- Severe anxiety.
- Nausea or vomiting.
- Dizziness.
- Headache or migraine.
- Palpitations.
- Blurred vision.
- Nosebleed.
- Seizures.
What Are the Complications of Hypertensive Crisis?
If left untreated hypertensive crisis can lead to severe complications such as:
- Heart attack.
- Stroke.
- Pulmonary edema.
- Myocardial infarction.
- Dementia.
- Aneurysm.
- Aortic dissection.
- Hypertensive retinopathy.
How Are Hypertensive Crisis Diagnosed?
The physician will take a detailed medical history of the prescribed and over-the-counter medications taken by the individual. Any history of heart disease, surgeries, and other diseases will be inquired.
The blood pressure of the individual will be taken in both arms and may repeat the test. If the individual had any organ damage accompanying high blood pressure, it will be considered a hypertensive emergency and treatment will be commenced immediately.
In other individuals with high blood pressure, the following tests will be conducted to look for or rule out hypertensive emergencies.
- Blood test.
- Urine test.
- Ophthalmic or eye examination.
- Chest X-ray.
- Magnetic resonance imaging (MRI) - An imaging test that creates an image of the body with the help of a large magnetic field and radio waves.
- Computed tomography (CT) - An imaging technique that produces a detailed cross-sectional image of the body parts.
- Electrocardiogram (ECG) - It records the various electrical signals present in the heart.
- Transthoracic echocardiogram (TTE) - With the help of ultrasound or sound waves, the image of the hear is produced.
In addition, blood pressure will be monitored regularly.
How Are Hypertensive Crisis Treated in Older Adults?
The treatment of hypertensive crisis will depend on various factors. However, the treatment aims to bring down the level of blood pressure. The medications are administered intravenously for fast action as well as to prevent further organ damage. However, they can also be administered through other routes like oral, sublingual, and transdermal. Common medications of choice are;
- Nitroglycerin.
- Nifedipine.
- Nitroprusside.
- Esmolol.
- Clevidipine.
- Clonidine.
- Hydralazine.
In most cases, blood pressure is reduced by 10 to 15 % in the first hour and another 10 to 15 % in the next two to four hours. However, this does not apply to all conditions. In an aortic aneurysm, blood pressure has to be lowered quickly to 120/70 mmHg while in hemorrhagic shock, the lowering of blood pressure has to be delayed unless it is more than 200/100 mmHg.
These medications can save patients from organ damage and other severe complications. In patients where organ damage occurred already, preventive strategies and medications are given to prevent further organ damage, and specific treatment is done for the damaged organ. However, the following side effects may be experienced by patients:
- Headache.
- Tachycardia or increased heart rate.
- Vomiting.
- Local phlebitis or inflammation of the vein.
- Bronchoconstriction.
- Heart failure.
- Hypotension.
How to Prevent Hypertensive Crisis During Old Age?
Hypertensive crisis during old age can be prevented by:
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Take the prescribed medication for hypertension on time. For individuals who have difficulty remembering, pill organizers or alarms would be useful.
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Avoid drinking alcohol or limit the intake of alcohol.
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Avoid smoking as it can increase blood pressure and sometimes may predispose to hypertensive crisis.
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Eat a healthy diet. Limit the intake of foods rich in salt and sugar. Consume more low-fat dairy products, whole grains, fish, poultry, fruits, and vegetables.
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Exercising regularly and being physically active can lower the risk of high blood pressure.
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As blood pressure decreases during sleep, it is mandatory to sleep at least seven hours every day.
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Reduce stress by practicing relaxation techniques like meditation, yoga, Tai chi, and breathing exercises.
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Connect to the emergency services when any symptoms like chest pain, vision blurring, or shortness of breath show up.
Conclusion
A hypertensive crisis is a significant life-threatening condition that may occur in individuals with hypertension. It commonly occurs when they forget to take their prescribed anti-hypertensive medication which leads to the spiking of blood pressure. During hypertensive crisis, individuals may experience shortness of breath, sweating, vomiting, headache, etc. In severe conditions, hypertensive crisis may result in organ damage. It is considered an emergency and has to be treated immediately. However, hypertensive crisis can be prevented in hypertensive patients by following a healthy lifestyle and being extra cautious.
