Hypertension is characterised by a persistent pathological increase in arterial blood pressure.
(The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 2003)
|Blood pressure category (mm Hg)
|Hypertension stage I
|Hypertension stage II
At least 20% of patients with hypertension do not know that their blood pressure is elevated.
In approximately 90% of the cases, no definitive cause of hypertension can be determined by modern diagnostic techniques.
Hypertension symptoms are unspecific:
- Headache, especially in the early morning
- Visual disturbances
- Heart failure
The body reacts with a hypertrophy of blood vessels which favours atherosclerosis.
The cardiac muscle pumps against an increased resistance which also results in hypertrophy.
Consequences of the vascular damage to the heart are congestive heart failure, CHD and arrhythmias.
Vascular damage in other organs results in damage to the eyes, kidneys, etc.
Pursuant to the recommendations of the Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure, the term used in the past (hypertensive crisis) - which was defined as dangerous elevation of blood pressure with associated symptoms - is no longer used.
Today we distinguish between the terms "hypertensive emergency" and "hypertensive urgency" (Joint National Committee 2003).
Critical elevation of blood pressure (e.g. > 230/130mm/Hg) without symptoms of acute organ damage
The absolute blood pressure height plays a subordinated role.
General clinical signs are rather unspecific.
Clinical symptoms of hypertensive urgency include the following:
Treatment of hypertensive urgency
- Disturbed vision
- In hypertensive urgency, it is sufficient to discontinue dental treatment and control blood pressure after 30 minutes rest and lower it within 24 hours. Do not intent quick lowering of the blood pressure since the body's auto-regulatory mechanisms are changed and quick lowering may result in insufficient blood supply to the brain, the kidneys and the eyes.
- Bring the patient in a sitting position.
- Oxygen administration 4-6 L/min
- Consult the patient's primary care physician and refer to an emergency department, if necessary.
Hypertensive emergency is defined as a dangerous increase in blood pressure associated with acute organ damage.
Here, the absolute blood pressure is not the decisive criterion but the re-occurrence or worsening of cerebral, cardiac or vascular life-threatening organ damage.
The general clinical signs are rather unspecific.
Clinical symptoms of hypertensive emergency may be
- Angina pectoris
- Neurological deficits (paraesthesia, paresis)
- Disturbances of consciousness or even coma.
- Hypertensive encephalopathy with a risk of stroke
- Development of a cerebral oedema
Treatment of hypertensive emergency
- acute left ventricular failure with pulmonary oedema
The reason for this is a peripherally increased resistance (afterload)
- Acute coronary syndromes (such as angina pectoris, myocardial infarction)
The cardiac muscle works against high pressure which results in an increased oxygen consumption of the heart; at the same time, the high tension of the muscle walls makes the filling of the coronary arteries more difficult.
In case of hypertensive emergency the blood pressure should be decreased appropiately and the inpatient admission under monitoring should take place immediately evidence.de Hypertonie-Therapie
Preparations of first choice:
- Sublingual nitroglycerin
Dosage: Have the patient chew 1 capsule or administer 2 puffs of the spray
One capsule contains 0.8 mg, one puff 0.4 mg nitroglycerin.
Nifedipin sublingual should not be used because of the danger of pronounced reflex tachycardias and a too rapid blood pressure lowering (Chest et Marik 2001)
- Bring the patient in a sitting position
- Oxygen administration 4-6 L/min
- At the same time, call for emergency assistance.