Hypertensive crisis: How does it manifest and what its treatment? High pressure- what endangers health?

Hypertensive crisis: How does it manifest and what its treatment? High pressure- what endangers health?
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Hypertensive crisis is a life-threatening condition characterized by a sudden and sharp increase in blood pressure. It is accompanied by the risk of damage and failure of vital organs.


Hypertensive crisis is acute health and life-threatening condition. More precisely, a sudden and sudden rise in blood pressure, which requires immediate treatment.

The level of blood pressure is not so decisive.
However, in this case, it weighs just: 
The rate of increase in blood pressure
Plus, the accompanying symptoms are significant.

Accompanying symptoms = health problems associated with the hypertensive crisis.


First of all, the hypertensive crisis is associated with the nervous system, more precisely with the central nervous system (CNS). The change in brain function is mostly accompanied by visual manifestations.


They also found signs of damage and failure of the cardiovascular system and kidneys.

1 + 2 = it is therefore a threat to the function of vital organs.

What is hypertension?

Hypertension, a hypertensive disease, is a technical term for high blood pressure. This disease is one of the most common cardiovascular diseases.

It affects up to 25% of the world's population.

High blood pressure is a risk factor for various health complications and diseases. Especially in case of neglect of treatment.

The name Silent Killer belongs to him also because for many years it can take place without symptoms. Health problems appear only after the disruption of the function of a particular organ or organ system.

High blood pressure can also occur after excessive physical activity, mental overload.

However, hypertension as a disease is assessed when blood pressure rises permanently above:

140/90 mmHg


There must be at least two independent measurements to measure the pressure value above this limit.

High blood pressure is not a term that only affects the adult population. It also affects children. The main causes are the wrong way of life associated with overweight to obesity or other diseases.

Thus, hypertension is divided into primary and secondary according to the cause

Primary = essential that has no known cause.

Secondary = arises from another disease.
Examples include kidney disease, hormonal changes, preeclampsia to eclampsia in pregnant women, and others.

Up to 95% of cases = essential / primary hypertension.

In the event of high blood pressure, so-called uncontrollable and influenceable risk factors are mentioned. The person cannot change the first group by his actions, while the second is directly related to the development of hypertension.

The most well-known risk factors  for hypertension include:

  • older age
  • gender, more common in menopausal women (menopause)
  • genetic predisposition and familial occurrence
  • imbalance of vasomotor regulation

Risk factors caused by human behavior:

  • overweight and obesity
  • excessive NaCl salt intake
  • lack of magnesium, potassium, and calcium in the diet
  • smoking
  • alcoholism
  • lack of exercise and sedentary lifestyle
  • overall poor lifestyle
  • negative impact on the environment, pollution

The European Society of Hypertension and the European Society of Cardiology report blood pressure values ​​as shown in the table

TK Systolic blood pressure in mm HG Diastolic blood pressure in mm HG
Optimal blood pressure less than 120 less than 80
Normal blood pressure 120 - 129 80 - 84
High normal blood pressure  130 - 139 85 - 89
Grade 1 hypertension - mild  140 - 159 90 - 99
Grade 2 hypertension - moderate  160 - 179 100 - 109
Grade 3 hypertension - severe  180 - 209 110 - 120
Grade 4 hypertension - very severe 210 and more more than 120
Isolated systolic hypertension more than 140 less than 90

Systole and diastole?

The heart as a pump draws deoxygenated blood from the human body.
He guides her through the lungs, where she becomes oxygenated again. 
He then pumps it back into the body.

In short ...

During contraction, ie the contraction of the myocardium - the heart muscle, the blood is expelled into the aorta. Then the blood pressure is highestIt should not exceed 140 mm Hg (millimeters of mercury - a method for measuring blood pressure).

We are talking about systole - the phase of contraction of the heart muscle and the expulsion of blood into the bloodstream.

Diastole, on the other hand, is a phase of relaxation. Occurs after contraction of the ventricles, blood is sucked into the heart. The diastole value should not be higher than 90 mm Hg.

Systole is also abbreviated sTK, TKs, diastole dTK, TKd.

Nowadays, in the home environment, we measure blood pressure using a digital sphygmomanometer, not a mercury sphygmomanometer using a mercury column.

For more information on blood pressurehow to measure
it properly,
and hypertension, see

In the article on hypertensive crisis you will read: 
Definition of hypertensive crisis and value of blood pressure
Manifestations and what treatment it has.

Defining a hypertensive crisis

A hypertensive crisis is an acute, life-threatening condition that accompanies damage or failure of vital organs.

The primary nervous system, heart, large blood vessels, and kidneys are affected in the first place.

In this case, it is important that the measured value of blood pressure, but the rate of increase and associated symptoms

In a hypertensive crisis, approximate blood pressure values ​​are given when blood pressure may rise above

TC 210 / 130 mm Hg.

Baseline is also important for blood pressure and its increase

A person with long-term elevated blood pressure tolerates the output of BP values ​​differently than a person with long-term normal blood pressure. 

An example:
Baseline value 120/80 or 170/90 and blood pressure rise above 200/100. 

Of course, each person perceives an increase in blood pressure individually.

In the case of a hypertensive crisis, two basic terms are mentioned,
which divide it into an emergency and an urgent condition .

Emergent condition

Emergencies are situations that are characterized by an acutesudden and sharp increase in blood pressure from a normal or elevated value.

Increased pressure is associated with associated serious health problems. Those resulting from the disability of target organs such as the brain, cardiovascular system, and kidneys.

Emergency = immediate treatment. 

In this case, it is stated that treatment is necessary within 1 hour.

A reduction in blood pressure is necessary to prevent damage to organs. However, blood pressure does not decrease at this point to the normal value of 120/80 mm Hg.

Such a significant reduction would cause unwanted non-blood flow to these important organs.

The treatment is mostly intravenous, ie parenteral - administered outside the digestive tract and the condition requires follow-up in the intensive care unit. Where basic vital signs are monitored and blood pressure (BP) is measured repeatedly.

Urgent conditions

Significantly elevated blood pressure is described as an urgent condition, but without the accompanying severe symptomatology.

Even in this situation, treatment is necessary to prevent the development of the condition.

However, it takes several hours. Oral orally treatment is generally sufficient. 

Emergent and urgent condition in the table

Emergent conditions Urgent conditions
  • acute - life threatening condition
  • there is a risk of failure of vital organs such as the brain, heart or kidneys
  • requires immediate treatment, within an hour
  • a serious condition that does not endanger a person immediately in life
  • requires treatment within a few hours
hypertensive encephalopathy hypertension in chronic heart failure
hypertension with acute heart failure accelerated hypertension
hypertension with acute coronary syndrome malignant hypertension
hypertension during aneurysm dissection after surgery hypertension
stroke hypertension
hypertension in preeclampsia and eclampsia
hypertension during surgery
hypertension in pheochromocytoma,  adrenal tumor
hypertension after drug use

WARNING!  If the hypertensive crisis is not treated in time, there is a risk of death due to damage caused to the brainheart or kidneys.


What are the causes of the hypertensive crisis ?

The exact cause of the hypertensive crisis is still unclear . However, some conditions that contribute to its occurrence are listed.

The most common reason for this life-threatening condition is untreated or insufficiently treated primary hypertension  or a complication of secondary hypertension .

It happens that this is the first manifestation of hypertension .

It is often caused by omitting the treatment of high blood pressure.
Forgotten treatment?
But also intentionally:
In the evening I go to a party, I will drink alcohol

Hypertensive crisis can affect any hypertensive, based on external stimuli, mental tension, but also in the worsening of another disease.

Summary of the causes of the hypertensive crisis :

  • untreated or inadequately treated hypertension
    • the first manifestation of high blood pressure
  • omission of drugs for high blood pressure - Rebound phenomenon
  • excessive mental stress and emotional stress
  • preeclampsia , eclampsia in pregnant women
  • renal impairment
    • acute renal inflammation, acute glomerulonephritis also in children
  • heart muscle infarction
  • bleeding into the brain or ischemia of the brain
    • stroke
  • brain tumor
  • cancer
  • head injury
  • postoperative conditions
  • pheochromocytoma
  • stimulant drugs, cocaine, crack, methamphetamine, LSD

Plus ...

It is stated that the crisis affects the  group of people with secondary hypertension , poor tolerance of antihypertensive treatment , smokers, and people with poor socio-economic  level (adherence to treatment, lifestyle?) To a greater extent .


In a  hypertensive crisis, it is reported as a major disorder of the central nervous system . This is a condition called encephalopathy

In this case, the possible problems are, such as headache, dizziness, nausea (vomiting) to vomiting, irritabilityconfusion, impaired consciousness, and even coma. The associate may even have convulsions.

Due to changes in the back of the eye, visual disturbances can also occur. Whether foggy, blurred, or double vision.

A serious consequence of the crisis is bleeding into the brain, such as intracerebral or subarachnoid hemorrhage.

Cardiovascular problems manifest as nasal bleeding, ie epistaxis , heart failure,  and pulmonary edema, or heart muscle infarction, as well as an  aortic aneurysm .

Renal symptoms are decreased renal function and reduced cessation of urine production.

The table lists the most common symptoms of a hypertensive crisis

System Symptoms
  • severe headache
  • dizziness
  • tinnitus
  • confusion
  • irritability, restlessness
  • stroke
  • disorder of consciousness
  • drowsiness - somnolence
  • coma
  • body cramps 
Eye symptoms
  • retinal haemorrhage
  • optic nerve papillary edema
  • vision disorders
    • blurred and foggy vision
    • double vision
Cardiovascular system
  • chest pain - angina pectoris
    • worsening of angina pectoris 
    • to acute coronary syndrome (ACS) - myocardial infarction
  • arrhythmia - heart rhythm disorders
  • epistaxis - nosebleeds
  • heart failure
  • shortness of breath - dyspnoea
  • swelling of the lungs
  • aortic aneurysm - dissection
    • sudden, severe, unbearable to severe chest pain
    • different blood pressure on two limbs
    • missing pulse on one limb
  • renal failure
    • reduced urine production - oliguria
    • cessation of urine production - anuria
    • hematuria - hematuria
    • protein in the urine - proteinuria
Digestive problems
  • nausea - feeling sick (vomiting)
  • vomiting 


Diagnosis relies primarily on anamnesis and examination of physiological functions .

Important questions in this case are:

  1. is the patient being treated for hypertension?
    • if so - for how long
  2. does he check his blood pressure?
  3. What medication does he have for high blood pressure?
  4. did he miss a treatment?
  5. Hasn't he drunk alcohol before, haven't he used drugs?
  6. have you had a similar condition or hypertensive crisis in the past?
  7. overcame a stroke, heart attack, has chronic heart failure?
  8. has the following difficulties:
    • headache
    • chest pain
    • palpitations - palpitations
    • difficulty breathing
    • visual impairment
    • dizziness
    • possibly other difficulties ...

Severity is also assessed according to:  

  1. current blood pressure
  2. original blood pressure
  3. rate of increase.

As with hypertension, organ involvement should be identified. The clinical picture leads to the need for a specialist. This can be a cardiologist, internist, neurologist.

Subsequently, if hypertension has not yet been diagnosed, an ophthalmologist and nephrologist. 

The basic examinations include the measurement of blood pressure, ECG, or CT in case of neurological deficit. A blood laboratory test will also be added. 

The basis is ...

Blood pressure and pulse are measured on both limbs.
Which may reveal a dissecting aortic aneurysm.
An indicative neurological examination is performedAn  ECG is added

Of course, reducing blood pressure to an acceptable level is paramount.

In a hypertensive crisis, its rapid detection is important , followed by early treatment . Subsequently, at a later stage , differential diagnosis is performed and performed .


In the case of a hypertensive crisis, a clear course cannot be described . The symptoms of hypertension are individual. It also depends on the rate and rate of increase in blood pressure and baseline at the time of increase.

There are people who have had high blood pressure for a long time. Their increase from TK 150/90 to 210/120 may not cause such severe problems. In that example, it may take place as an emergency .

Only systolic or diastolic blood pressure can rise.

On the other hand, there are people who usually have normal values. In this case, a hypertensive crisis may cause an emergency  with immediate treatment .

In hypertensive emergencies , and the rise in diastolic pressure above 120 mmHg DBP is generally reported.

Otherwise, there is a risk of serious complications, including stroke, bleeding into the brain, myocardial infarction, heart failure, and other disease states.

However, the hypertensive crisis usually takes place as a triad affecting the nervous, heart, and kidney systems.

First and foremost, there are symptoms of brain dysfunction. Examples are intense headaches, dizziness, confusion, and disturbances of consciousness. Feeling sick to vomiting and visual disturbances may be associated.

Subsequently, heart problems develop, such as left heart failure with difficulty breathing, or chest pain with the risk of developing a myocardial infarction.

The kidneys are affected by dysfunction that is reflected in reduced to stopped urine production. Alternatively, blood and excess protein enter the urine.

Hypertensive crisis - an emergent form requires immediate treatment
Imminent complications such as bleeding into the brain
failure or heart attack
up to death .

How it is treated: Hypertensive crisis

Treating hypertensive crisis: Immediate treatment is necessary. Why? It is a matter of time...

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Interesting resources

  • Papadopoulos DP, Mourouzis I, Thomopoulos C, Makris T, Papademetriou V (December 2010). "Hypertension crisis". Blood Press19 (6): 328–36. 
  • Fisher ND, Williams GH (2005). "Hypertensive vascular disease". In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1463–81. ISBN 978-0-07-139140-5.
  • O'Brien, Eoin; Beevers, D. G.; Lip, Gregory Y. H. (2007). ABC of hypertension. London: BMJ Books. ISBN 978-1-4051-3061-5.
  • Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest131 (6): 1949–62. 
  • Chobanian, AV; Bakris, GL; Black, HR; Cushman, WC; Green, LA; Izzo JL, Jr; Jones, DW; Materson, BJ; Oparil, S; Wright JT, Jr; Roccella, EJ; National High Blood Pressure Education Program Coordinating Committee (Dec 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension42 (6): 1206–52
  • ncbi.nlm.nih.gov  - Hypertensive crisis