Hypertensive Crisis

Hypertensive Crisis: A severe and abrupt elevation in blood pressure, with a systolic BP above 180 mmHg and a diastolic BP above 120 mmHg.

Hypertensive crisis is acute and life-threatening, this requires emergency treatment due to target-organ damage which is called hypertensive emergency. If the patient’s blood pressure is severely elevated but there is no clinical evidence of target-organ damage therefore this is categorized as hypertensive urgency.

Signs and symptoms

• High blood pressure (diastolic pressure higher than 120 mm Hg)

• Headache

• Drowsiness and confusion

• Blurred vision

• Changes in neurological status

• Tachycardia and dyspnea

• Cyanosis

• Seizures
  

Interventions

• Maintain a patent airway.

• Hypertensive emergency: Administer antihypertensive medications intravenously as prescribed e.g., nitroprusside (Nitropress), diazoxide (Hyperstat), nicardipine (Cardene), or labetalol (Trandate).

• Hypertensive urgency: Administer antihypertensive medications orally as prescribed e.g., clonidine (Catapress) or captopril (Capoten).

• Monitor vital signs (especially blood pressure) every 5 minutes.

• Assess for hypotension during treatment of antihypertensives; if it occurs position the patient in supine.

• Maintain bed rest with the head of the bed elevated at 45 degrees.

• Have emergency medications and resuscitation equipment available.
  

Main causes

• Patients with hypertension who are noncompliant to their prescribed medication or undermedicated.

• Use of cocaine or crack, amphetamines, phencyclidine (PCP), and lysergic acid diethylamide (LSD).

• Patients who are taking monoamine oxidase inhibitors (MAOIs) who consume foods rich in tyramine.

Potential complications

• Hypertensive encephalopathy

• Intracranial or subarachnoid hemorrhage

• Acute left ventricular failure with pulmonary edema

• Myocardial infarction

• Renal failure and dissecting aortic aneurysm
  

Laboratory assessments/Diagnostic Test

• Monitor intake and output; if oliguria or anuria occurs, notify the physician.

• Monitor IV therapy; assessing for fluid overload.
  

Education 

• Determine and avoid the cause of the hypertensive crisis (e.g., compliance to medication, avoiding illicit drugs, and avoiding tyramine rich foods if taking MAOIs).