Nothing can put a patient into the intensive care unit faster than a high blood pressure (hypertension) crisis. Once a patient has reached this stage, he is at high risk for stroke, heart attack and even kidney failure. Prompt treatment is necessary to bring blood pressure down to a safe level.
Symptoms
Symptoms of a high blood pressure crisis vary. Common symptoms are headache, blurry vision and altered consciousness. Damage to the retina because of high pressure in the eye is also common. Such symptoms can lead to serious conditions, such as heart attack, stroke or kidney failure. These symptoms are very important because they guide treatment decisions.
Risks
Curiously, bringing blood pressure down too rapidly has its own risks, so the goal of treatment is to lower blood pressure 25 percent within the first 24 hours and continue bringing it down in the days thereafter. In a review article appearing in the journal Clinical Care, Drs. Joseph Varon and Paul Marik warn that "rapidly lowering an elevated blood pressure is associated with significant morbidity and death" because bodies of chronically hypertensive patients have lost the ability to auto-regulate and maintain homeostasis.
Intravenous Treatment
Initial treatment is usually in the emergency room or intensive care. A fast-acting drug is injected intravenously while blood pressure is carefully monitored. Varon and Marik recommend a 10 percent to 15 percent reduction in the diastolic pressure as an immediate short-term treatment goal. The speed with which this goal is reached is balanced against the risk of bringing blood pressure down too quickly. For example, pressures in a patient with a dissecting aneurysm should be reduced by this amount within 5 to 10 minutes, whereas pressures for other patients can be reduced over the span of an hour.
Fluids
Patients having a hypertensive crisis are also commonly dehydrated. Replacing lost fluid volumes is a secondary goal of treatment.
Often, diuretics are given to hypertensive patients, either alone or in combination with other drugs. Patients who are having a hypertensive crisis are the exception to this practice because they already lack fluids.
Follow-Up
Once a stable blood pressure is achieved, oral blood pressure medicine is given, and the IV is discontinued. Many different categories of blood pressure medications can be helpful at this stage, including ACE inhibitors, beta blockers, calcium channel blockers and angiotensin receptor blockers.
