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What Is the Most Common Cause of Hypertensive Crisis?

Medically Reviewed on 2/9/2022

The most common cause of hypertensive crisis is a sudden increase in blood pressure in people with chronic hypertension

The most common cause of hypertensive crisis is a sudden increase in blood pressure in people with chronic hypertension, often caused by medical noncompliance.

Other causes of hypertensive crisis may include:

  • Not taking blood pressure medications
  • Severe stress or anxiety
  • Endocrine issues such as pheochromocytoma (rare adrenal gland tumor)
  • Hormonal imbalances due to conditions such as Cushing’s syndrome
  • Thyroid disease
  • Kidney failure 
  • Adrenal disease
  • Heart disease
  • Stroke
  • Cocaine or amphetamine use
  • Cigarette smoking or alcohol abuse
  • Burns, head injuries, or surgery
  • Side effects of certain drugs such as monoamine oxidase inhibitors

What are the risk factors of hypertensive crisis?

Hypertensive crisis is estimated to account for 3% of all emergency department visits. Risk factors include:

  • Male gender
  • Age (people ages 40-50 are more prone to developing the condition)
  • Lifestyle (high-sodium diet, alcohol use, and substance abuse)
  • Pregnancy-related diseases
  • Anemia
  • Diabetes
  • Dyslipidemia
  • Cardiovascular and renal comorbidities

What blood pressure readings indicate hypertensive crisis?

A sudden spike in blood pressure indicate a hypertensive crisis:

  • Hypertensive urgency (over 180 mmHg or 110-120 mmHg)
    • May not have end-organ damage but a gradual blood pressure reduction over hours or days is indicated.
    • Untreated hypertensive emergencies can develop because chronically high blood pressure can cause end-organ damage.
  • Hypertensive emergency (over 180-220 mmHg or 120-130 mmHg)
    • End-organ damage to the cerebrovascular, cardiovascular, or renovascular systems that begins or progresses.
    • Blood pressure should be checked frequently to avoid catastrophic organ damage and done over minutes to hours.

How is hypertensive crisis diagnosed?

Your doctor will take your medical history to determine whether you have any underlying conditions, history or surgery, or are currently on any medications. They will also measure your blood pressure on both arms several times to determine whether you are in hypertensive crisis. Tests may include:

  • Blood or urine tests: To assess whether your liver and kidneys are functioning properly (high blood pressure can damage the kidneys)
  • Electrocardiography: To check for any abnormal electrical activity due to hypertensive crisis in the heart
  • X-ray or computed tomography scan: May be ordered if your doctor suspects end-organ damage

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How is hypertensive crisis treated?

Hypertensive crisis is a medical emergency that requires immediate attention. Treatment options include measures to reduce stress and lower blood pressure via intravenous or oral medication. 

The immediate goal of treatment is to gradually lower blood pressure to a safe level. Target blood pressure and the rate at which it should be reduced will vary depending on the cause, severity of symptoms, and overall condition of the patient.

Treatment may include:

  • Rest: If a person is experiencing hypertensive crisis without other symptoms or organ damage, simply sitting in a quiet room and resting may help lower blood pressure.
  • Oral medications: If a person is experiencing a hypertensive crisis without other symptoms or organ damage, or if blood pressure has already been lowered with medications administered, oral medications may be recommended to maintain lower blood pressure.
  • Intravenous medications: Medications may be administered intravenously to reduce blood pressure levels faster.

In some cases, patients must be treated in intensive care with a continuous infusion of a titratable short-acting antihypertensive drug. The goal is to reduce blood pressure by no more than 25% in a short period of time.

Can hypertensive crisis be prevented?

Hypertensive crisis may be prevented with the following measures:

  • Monitor blood pressure at home daily, noting readings and discussing them with your doctor weekly
  • Take medications as prescribed for conditions such as diabetes
  • Ask your doctor about current medications, as some drugs can increase blood pressure levels
  • Limit your intake of sodium and potassium
  • Exercise regularly to maintain a healthy weight
  • Reduce stress
  • Limit alcohol
  • Quit smoking

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Medically Reviewed on 2/9/2022

References

Image Source: iStock Images

WebMD. High Blood Pressure and Hypertensive Crisis. https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertensive-crisis

University of Rochester Medical Center. Hypertensive Crisis. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/critical-care-nursing-symposium/documents/Hypertensive-Crisis.pdf

St. Clair Hospital. Hypertensive crisis: What are the symptoms? https://www.stclair.org/services/mayo-clinic-health-information/faqs/FAQ-20058491/

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