Everything You Need to Know About Hypertensive Crisis

Almost 7% of the body weight of a normal human being constitutes of blood. Blood circulates around the body in order to supply nutrients and exchange gasses. The force which the circulating blood of a person exerts on the walls of its blood vessels is known as the blood pressure. Blood pressure is measured with the help of instrument known as sphygmomanometer. It takes into account the flow of blood as well as the resistance caused by arteries to the flow of blood. Normal range for blood pressure is 120/80 mm Hg but it varies according to age. If blood pressure is low, we call it hypotension, and if the blood pressure is high, we call it hypertension.

Epidemiology

More than 50% of the total individuals of the United States have hypertension. Hypertension affects over 65 million Americans. In 2000, it caused 250,000 deaths in USA (Aggarwal & Khan, 2006). Globally, hypertension is responsible for 4.5% of the total disease burden (Organization & Group, 2003). Hypertension has been detected in adults as well as children and adolescents (Önal, Erbil, Özel, Aciksari, & Tumerdem, 2004).

Risk factors

Risk factors for the cause of hypertension include age, ethnicity, body to mass index, intake of alcohol and tobacco, low potassium and salt rich, high fat diet, and sedentary life style are the major factors for developing hypertension.

People who are above the age of 60 tend to be hypertensive. It is because of the fact that arteries become weak and less flexible due to deposition of plague. As far as ethnicity is concerned, some groups are more prone to hypertension as compared to other ethnic groups. For example, African Americans develop hypertension more frequently as compared to other groups. High BMI is a serious risk factor for hypertension. Regular consumption of alcohol also leads to developing hypertension.

hypertensive crisis

image by Dr. Tess Villa

Causes

The exact cause of hypertension is not defined and is not known (Kulkarni, O’Farrell, Erasi, & Kochar, 1998). Usually any stress or some underlying condition is the reason which leads to hypertension. Hypertension tends to run in some families, so the reasons can be genetic as well(Oparil, Zaman, & Calhoun, 2003; Organization & Group, 2003).

Hypertension can be primary or secondary. If blood pressure is high, but there is no other underlying condition responsible for it, it is called primary hypertension(Runo & Loyd, 2003). But if there is some underlying factor, then this condition is known as secondary hypertension. Primary hypertension may be caused by environmental factors, for example stress or sedentary life style, or any medication, for example medicine used for managing hormonal activity. However, secondary hypertension occurs because of particular reasons and is normally result of some other serious problem (Falkner, 2010).

Kidneys are responsible for filtration of blood. In case of chronic kidney disease, kidneys do not filter the blood properly, as a result of which large volume of fluid retains in the blood which causes high blood pressure. Besides kidney disease, diabetes, pheochromocytoma, cushing disease, thyroid abnormalities and pregnancy are the major factors which lead to hypertension (Obstetricians & Gynecologists, 2013).

Genetic Basis of Hypertension

Multiple genetic factors have been found to play role in primary hypertension in grown up individuals; however, in case of children, delineation of genetic factors in the separate populations with primary or secondary hypertension have not been well understood (Renee F. Robinson, Batisky, Hayes, Nahata, & Mahan, 2005). According to a recent research published, genetic factors involved in the development of primary and secondary hypertension are not the same. Primary hypertension in children and adolescents occurs because of large number of additive contributions of genes. This fact cannot be ignored that environmental factors are also responsible.

Symptoms

There are no peculiar signs and symptoms of hypertension. Most of the people do not notice any change in the blood pressure. This is the reason why it is known as “The Silent Killer”. It can be very dangerous as it can lead to damage to heart and kidneys as well. Blood vessels are also weakened due to persistent high blood pressure. Rarely, hypertension can lead to anxiety, sleep apnea or sweating or blushing. If hypertension develops to hypertensive crisis, nosebleeds and headaches can also occur.

Outcomes

Hypertension can lead to coronary heart disease, kidney problems and even stroke.

Management and treatment

Improved lifestyle is the best solution of hypertension apart from hypertension. Some of the remedies and adjustments in the lifestyle are given below.

  • Regular exercise

Regular physical exercise can help in avoiding hypertension. Doctors suggest moderate physical exercise of 1 hour and 30 minutes or 75 minutes of intense exercise per week to avoid hypertension. Physical exercise includes walking, cycling, jogging or other aerobics (Pescatello et al., 2004).

  • Lessen the stress

Stress is a major factor which causes hypertension (Kulkarni et al., 1998). Multiple techniques can be employed to reduce the stress for example, yoga, meditation etc. psychologists keep on emphasizing the importance of stress management techniques in order to avoid depression and hypertension (Dahl, 1972; Staessen, Wang, Bianchi, & Birkenhäger, 2003).

  • Say No to drugs

Hypertension is more common in people who take alcohol, tobacco or other drugs. To surprise, junk food can also lead towards hypertension. Therefore, these things should be avoided as much as possible.

  • Smoking

Cigarettes are a cause of increased blood pressure. Active as well as passive smoking can damage the arteries. Therefore smoking should be avoided as much as possible as it can help in controlling blood pressure and hypertension will be avoided.

  • Medication

Allopathic, homeopathic and herbal medicines are used for controlling blood pressure.  Beta blockers are commonly used for controlling elevated blood pressure. However, in case if the patient does not respond, other combination of multiple drugs is also used in clinical practices(Conditions, 2006; Wiysonge, Bradley, Volmink, Mayosi, & Opie, 2017). These medicines have been found to be responsible for causing multiple side effects in the patients (Conditions, 2006; Gradman, Basile, Carter, Bakris, & Group, 2010; Renee F. Robinson et al., 2005; Wiysonge et al., 2017).

  • Balanced diet

Balanced and healthful diet is the key to control hypertension. The U.S. National Heart, Lung, and Blood Institute (NHLBI) suggests a special diet plan for which is known as DASH diet for people with hypertension. It helps in lowering high blood pressure, improving the levels of fats in the blood and reducing the risk of heart diseases.

The NHLBI generates a cookbook known as ”Keep the Beat Recipes” that provides ideas for food for controlling blood pressure. According to a recent research, probiotics supplements may help in controlling the hypertensive condition.

  • Lesser salt intake

World Health Organization (WHO) recommends intake of 5g of salt daily to reduce the probability of developing hypertension and other heart diseases. But unfortunately, average intake of salt in common people is between 9-12 grams in almost all the countries. Normal intake of salt is good for people with or without hypertension(Dahl, 1972).

  • Avoiding alcohol

Alcohol consumption increases the blood pressure. American Heart Association (AHA) suggests two drinks for men and one for women to be safe.

  • More fruits and vegetables, and less fat

Healthy eating habits are important in avoiding many diseases. Same goes for hypertension as well. High blood pressure can be avoided by using less fats, more fruits and vegetables, whole grain food, high fibre diet, beans, pulses and nuts, fish and low fat dairy products.

People with high BP or those who are prune to developing high BP should avoid saturated and total fat as possible.

Some oils are good for health for example olive oil and fish oil. They help in protecting the heart from diseased condition. But in case if the person is already a patient of hypertension, he should carefully measure the amount of oils being used in his diet and then replace unhealthy oils with healthy oils(Organization & Group, 2003).

  • Managing body weight

It has been righteously said that obesity is the mother of all diseases. A balanced BMI helps in avoiding hypertension(Obstetricians & Gynecologists, 2013; Renee F Robinson, Batisky, Hayes, Nahata, & Mahan, 2004).

Complications due to hypertension

If hypertension prevails for long, it can lead to complications. It can be responsible for atherosclerosis where plaque gets deposited on the walls of vessels, ultimately narrowing them and hence increasing the blood pressure. In this situation, heart has to work even harder to pump the blood whereas narrow arteries cause resistance to flow of blood.

Hypertension-related atherosclerosis can result in heart problems, kidney disease or even kidney failure, stroke, haemorrhage, limb amputation and optical retinopathies which can cause blindness.

The best way to avoid these complications is regular monitoring of blood pressure with the help of sphygmomanometer at home or at clinic.

Hypertensive crisis

Hypertensive crisis is a condition in which sudden and severe elevation in blood pressure occurs and it can lead to a stroke. Extremely high blood pressure with 180 mm Hg systolic and 120 mm Hg diastolic can lead to damage to the blood vessels. Hence the vessels may become inflamed and the body fluid may ooze out of the vessels. As a result of which it becomes difficult for heart to function properly (Frohlich et al., 1992).  There are two types of hypertensive crisis:

  • Hypertensive urgency
  • Hypertensive emergency

In an urgent hypertensive crisis, the blood pressure is very high, but the doctor doesn’t feel that the patient has got his organs damaged. However, in an emergency hypertensive crisis, elevated blood pressure damages the organs. It can lead to life threatening complications. Severe chest pain, anxiety, headache, seizures, nausea and vomiting are the symptoms which can point towards life threatening hypertensive crisis (Aggarwal & Khan, 2006; Vilela-Martin, Vaz-de-Melo, Kuniyoshi, Abdo, & Yugar-Toledo, 2011; Wolkowitz, Epel, & Reus, 2001).

In case of hypertensive crisis, the patient should immediately consult a doctor because it can lead to serious outcomes.

 

References

Aggarwal, M., & Khan, I. A. (2006). Hypertensive crisis: hypertensive emergencies and urgencies. Cardiology clinics, 24(1), 135-146.

Conditions, N. C. C. f. C. (2006). Hypertension: management in adults in primary care: pharmacological update.

Dahl, L. K. (1972). Salt and hypertension. The American journal of clinical nutrition, 25(2), 231-244.

Falkner, B. (2010). Hypertension in children and adolescents: epidemiology and natural history. Pediatric Nephrology, 25(7), 1219-1224.

Frohlich, E. D., Apstein, C., Chobanian, A. V., Devereux, R. B., Dustan, H. P., Dzau, V., . . . Massie, B. (1992). The heart in hypertension. New England Journal of Medicine, 327(14), 998-1008.

Gradman, A. H., Basile, J. N., Carter, B. L., Bakris, G. L., & Group, A. S. o. H. W. (2010). Combination therapy in hypertension. Journal of the American Society of Hypertension, 4(2), 90-98.

Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M. (1998). Stress and hypertension. WMJ: official publication of the State Medical Society of Wisconsin, 97(11), 34-38.

Obstetricians, A. C. o., & Gynecologists. (2013). Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstetrics and gynecology, 122(5), 1122.

Önal, A., Erbil, S., Özel, S., Aciksari, K., & Tumerdem, Y. (2004). The prevalence of and risk factors for hypertension in adults living in Istanbul. Blood pressure, 13(1), 31-36.

Oparil, S., Zaman, M. A., & Calhoun, D. A. (2003). Pathogenesis of hypertension. Annals of internal medicine, 139(9), 761-776.

Organization, W. H., & Group, I. S. o. H. W. (2003). 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Journal of hypertension, 21(11), 1983-1992.

Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004). Exercise and hypertension. Medicine & Science in Sports & Exercise, 36(3), 533-553.

Robinson, R. F., Batisky, D. L., Hayes, J. R., Nahata, M. C., & Mahan, J. D. (2004). Body mass index in primary and secondary pediatric hypertension. Pediatric Nephrology, 19(12), 1379-1384.

Robinson, R. F., Batisky, D. L., Hayes, J. R., Nahata, M. C., & Mahan, J. D. (2005). Significance of Heritability in Primary and Secondary Pediatric Hypertension. American Journal of Hypertension, 18(7), 917-921. doi: 10.1016/j.amjhyper.2005.01.010

Runo, J. R., & Loyd, J. E. (2003). Primary pulmonary hypertension. The Lancet, 361(9368), 1533-1544.

Staessen, J. A., Wang, J., Bianchi, G., & Birkenhäger, W. H. (2003). Essential hypertension. The Lancet, 361(9369), 1629-1641.

Vilela-Martin, J. F., Vaz-de-Melo, R. O., Kuniyoshi, C. H., Abdo, A. N. R., & Yugar-Toledo, J. C. (2011). Hypertensive crisis: clinical–epidemiological profile. Hypertension Research, 34(3), 367.

Wiysonge, C. S., Bradley, H. A., Volmink, J., Mayosi, B. M., & Opie, L. H. (2017). Beta‐blockers for hypertension. Cochrane database of systematic reviews(1).

Wolkowitz, O. M., Epel, E. S., & Reus, V. I. (2001). Stress hormone-related psychopathology: pathophysiological and treatment implications. The World Journal of Biological Psychiatry, 2(3), 115-143.

 

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