What is the blood pressure in a hypertensive crisis?

Written by Li Fang Xiao
Internal Medicine
Updated on September 15, 2024
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Hypertensive crisis is a relatively urgent medical condition in clinical settings. Its diagnostic criterion is a diastolic pressure greater than 130 mmHg. Naturally, the higher the blood pressure, the greater the threat. A hypertensive crisis can lead to many clinical symptoms, such as acute left heart failure, dizziness, headache, cerebral hemorrhage, and acute renal failure. The most common causes of hypertensive crisis are primary or secondary hypertension, which, under certain specific circumstances, lead to uncontrollably high blood pressure and related clinical symptoms. The focus of treatment is on controlling the blood pressure and choosing different treatment plans for complications. For instance, in the case of heart failure, vasodilators and diuretics may be used for symptomatic treatment.

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Written by Li Qiang
Intensive Care Unit
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How to treat hypertensive encephalopathy

The treatment goal for hypertensive encephalopathy is mainly to rapidly reduce blood pressure to a reasonable range. Typically, intravenous antihypertensive drugs are administered to decrease blood pressure by 20%-25% within the first hour, followed by oral antihypertensives or continued intravenous treatment to further reduce it to a more reasonable level. Hypertensive encephalopathy often accompanies cerebral edema, and patients may experience increased intracranial pressure. At this point, it is necessary to administer dehydrating agents such as mannitol to treat the cerebral edema. If the patient experiences seizures, which can cause an increase in blood pressure or difficulty in reducing blood pressure, sedative anticonvulsant drugs must be administered to control the seizures. If the patient shows signs of heart failure, diuretic treatment should be initiated. Additionally, high concentration oxygen therapy under high pressure should be administered, which can be delivered through nasal cannula. If nasal oxygen therapy is ineffective, non-invasive ventilation or even intubation with invasive ventilation may be used to provide high concentration positive pressure oxygen therapy.

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Written by Zhang Yue Mei
Cardiology
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Causes of high blood pressure

Hypertension is clinically divided into primary hypertension and secondary hypertension. Primary hypertension is characterized by elevated blood pressure without other symptoms, and the current clinical diagnostic methods cannot determine the cause of the blood pressure rise, which is referred to as primary hypertension. Secondary hypertension occurs as a result of other diseases, with the most common being hyperthyroidism, glomerulonephritis, arteritis, atherosclerosis, and other diseases causing high blood pressure. After the onset of hypertension, effective antihypertensive drugs must be used for treatment. Hypertension is not to be feared, but the damage it causes to the body is. (Specific medications should be used under the guidance of a physician)

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Written by Chen Tian Hua
Cardiology
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Is a blood pressure of 180 considered severe?

Blood pressure reaching a systolic level of 180 mmHg is considered severe hypertension, which is quite serious. This type of blood pressure requires active treatment with antihypertensive medications to gradually bring the pressure back to normal levels. This kind of blood pressure often requires the combination of different antihypertensive drugs with various mechanisms of action to effectively control it. It is recommended to select antihypertensive drugs under the guidance of a specialist doctor based on individualized treatment principles, starting with small doses. The reduction in blood pressure should not be too rapid nor should it cause the pressure to drop too low. In addition to standard antihypertensive treatment, long-term adjustments to lifestyle habits and changes to unhealthy behaviors are also necessary. If there are other related cardiovascular risk factors, they should also be actively managed.

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Written by Pan Wu Shan
Nephrology
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What is the difference between hypertensive nephropathy and renal hypertension?

There are fundamental differences between hypertensive nephropathy and nephrogenic hypertension. Firstly, hypertensive nephropathy occurs due to long-term high blood pressure, leading to complications in the kidneys. Generally, the history of hypertension exceeds ten years, and routine urine tests reveal a relatively small amount of protein in the urine. The main damage lies in the renal tubules, whose reabsorption and concentration functions are impaired. The primary treatment is to control the blood pressure well, possibly in conjunction with medication to protect the kidneys. On the other hand, nephrogenic hypertension originates from nephritis causing high blood pressure and is a form of secondary hypertension. In this condition, controlling blood pressure is particularly challenging. Usually, a significant amount of antihypertensive medication is required. Dietary considerations include a low salt and low fat diet, with daily salt intake limited to about three grams, maintaining regular schedules, and avoiding catching colds.

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How is hypertensive nephropathy treated?

Long-term hypertension can lead to abnormal kidney structure and function, also known as hypertensive nephropathy. Once hypertensive nephropathy is diagnosed, comprehensive treatment measures are often adopted, including both pharmacological and non-pharmacological treatments. In terms of non-pharmacological treatment, patients should maintain a low-salt diet in their daily life, focusing on a light diet, with a daily salt intake of about 4 grams. Regarding pharmacological treatment, the main goal is to control the patient's blood pressure and reduce urinary protein. Medications that can be used include angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists. Any of these medications can be chosen and used long-term to control blood pressure, protect kidney function, and reduce urinary protein. (Medications should be used under the guidance of a physician, and self-medication should be avoided.)