Emergency Treatment of Hypertension

Hypertension, or high blood pressure, is generally a chronic disease that does not require emergency treatment. In special circumstances, however, called hypertensive urgency and hypertensive crisis, or hypertensive emergency, blood pressure spikes to excessively high levels, straining the heart, blood vessels and lungs. These acute medical conditions can serious damage various organs or kill a victim who does not receive immediate and proper medical attention.

Physiological process

• In hypertensive urgency, the rapidly elevating blood pressure, while posing a significant risk, has not damaged tissue. In hypertensive crisis (or emergency), however, damage has started to occur in organs or tissue, typically resulting in symptoms. Chronic, out-of-control hypertension or precipitating factors---sudden withdrawal from some drugs, some forms of stroke; certain types of liver, kidney and endocrine disorders; and, in pregnant women, eclampsia---can cause either of those conditions.

  Blood pressure rises in response to growing fluid volume or elevated resistance in the blood vessels. Then, as the high pressure increases resistance, the blood flow can back up, overloading organs like the brain, kidneys, lungs or eyes. This backed-up blood flow damages tissue and poses life-threatening conditions such as cerebral hemorrhage or pulmonary edema.

Triage

• Due to tissue damage, hypertensive crisis is typically managed in the emergency department or intensive-care unit. Hypertensive urgency is typically handled through outpatient treatment with oral anti-hypertensive medications that relax the blood vessel walls and/or diuretics that decrease fluid levels.

  Rapid decreases in blood pressure can also damage tissue or organs. Therefore, the stabilizing treatments for hypertensive crisis must include proper blood-pressure monitoring with measures to stabilize the blood pressure should it start to drop too rapidly. The goal for treating hypertensive emergencies is not to drop the blood pressure to normal values but rather to start lowering the blood pressure to prevent further damage. Generally, for hypertensive crisis, IV (intravenous) fluids are started to give access for medications and to prevent sudden cardiovascular collapse when the blood pressure is lowered.

Hypertensive Crisis

• Hypertensive crisis treatments vary depending on which organ or tissues are being damaged and any precipitating factors. If hypertensive crisis has affected the brain, a patient may receive IV drugs---typically labetalol, which prevents natural blood vessel constrictions, and nitroprusside, which dilates the blood vessels. Kidney involvement is often treated with nicardipine, a calcium channel blocker that relaxes blood vessel walls. Eclampsia is treated with intravenous magnesium sulfate. Other medications may be appropriate depending on health history and patient responses to treatment.

  All treatments for hypertensive crisis must be administered in a controlled environment with access to resuscitation equipment. Throughout treatment, blood pressure, pulse and respiratory status are monitored closely. Adjustments to IV medications are made to keep the blood pressure dropping steadily but safely. Respiratory assistance may be given in the form of suction, breathing treatments, and chest tubes (if necessary).

Cautions

• Seek immediate medical intervention for any blood pressure greater than 180/120 millimeters of mercury. Hypertension that is accompanied by a pounding headache, dizziness, difficulty breathing, confusion, sudden muscle weakness, slurred speech, chest pain or bleeding in the eye should also be assessed by a physician immediately. Only trained medical professionals can properly assess and treat emergency hypertensive conditions.