Who is at risk?
Hypertensive crisis is normally seen among hypertensive patients who consistently have uncontrolled, elevated blood pressure possibly due to medication non-adherence, poor eating habits, taking supplements that could increase blood pressure or they may be completely unaware that they have hypertension.
Sign and Symptoms of Hypertensive Crisis
Some patients may experience little to no symptoms while others may experience symptoms including:
i) confusion
ii) severe anxiety
iii) chest pain (angina)
iv) shortness of breath
v) visual changes
vi) nosebleed
vii) fits or seizures
Clinically, to identify whether patient is suffering from either hypertensive urgency or emergency, the attending physician may order specific tests such as:
Routine blood pressure monitoring
Eye exam to assess for any bleeding or swelling
Blood and urine testing
Treatment options
Hypertensive Urgency:
Captopril 12.5mg
Nifedipine 10mg
Labetalol 200mg
Hypertensive Emergency:
IV Labetalol
Nitroglycerine
Isosorbide dinitrate
Hydralazine
It is worth noting that lowering BP abruptly is not favourable as it may obstruct blood flow to other organs that may require high blood pressure and cause decreased blood flow (ischemic events). For instance, in hypertensive urgency, blood pressure ideally should not decrease more than 25% of its initial reading over 24 hours and not lower than 160/100 mmHg. Meanwhile in hypertensive emergency, the desired outcome would be nothing more than a 25% reduction of BP in the first hour.
All in All
As the classic saying goes, prevention is better than cure. Due to the silent nature of hypertension, hypertensive crisis may happen unannounced to anyone, at any time. Thus, it is of utmost importance for all hypertensive patients to take their prescribed antihypertensives as instructed and to avoid taking any herbal supplements or traditional medicines without verifying through your doctor. Regular monitoring of BP alongside with tracking your BP readings in a logbook should also be practised to allow revision in treatment plan if BP is found to be high consistently.
Written by Janelle Leong, Bpharm(Hons);
Medically reviewed by Nur Ariffin, MBBS UniSZA
References:
High Blood Pressure and Hypertensive Crisis - WebMD
Available at https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertensive-crisis Accessed on 3rd September 2022
What to know about Hypertensive Crises - Medical News Today. Available at https://www.medicalnewstoday.com/articles/hypertensive-crisis Accessed on 3rd September 2022
Clinical Practice Guidelines Management for Hypertension (MOH) 5th Ed 2018. Available at https://www.moh.gov.my/moh/resources/penerbitan/CPG/MSH%20Hypertension%20CPG%202018%20V3.8%20FA.pdf Accessed on 3rd September 2022
Hypertensive Crises: Urgencies & Emergencies - US Pharmacist. Available at https://www.uspharmacist.com/article/hypertensive-crises-urgencies-and-emergencies#:~:text=Hypertensive%20urgencies%20may%20be%20treated%20on%20an%20outpatient%20basis%2C%20by,antihypertensives%20in%20an%20inpatient%20setting. Accessed on 3rd September 2022
The prevalence of hypertension among Malaysian adults and its associated risk factors: data from Malaysian Community Salt Study (MyCoSS) Available at https://pubmed.ncbi.nlm.nih.gov/34059165/ Accessed on 3rd September 2022
WHO Hypertension Fact Sheet. Available at https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=When%20symptoms%20do%20occur%2C%20they,chest%20pain%2C%20and%20muscle%20tremors Accessed on 4th September 2022