Severe Hypertension

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Stage 3 Hypertension

Are you newly diagnosed stage-3 HTN, what to do next? Be strong; severe hypertension requires immediate emergency treatment.

What is a stage-3 severe hypertension?

The third stage of hypertension is called stage 3 hypertension. Stage 3 hypertension is a severely elevated systolic pressure range over 180 mm Hg and the diastolic pressure range 110 mm Hg.

Stage-3 hypertension is considering as severe and needs urgent stringent medical treatment with more frequent monitoring to avoid any complication.

These patients may present in the following manner:

  • Asymptomatic patient (Neither causing nor exhibiting symptoms of disease).
  • Some patients have non-specific symptoms such as a headache, dizziness, lethargy.
  • Some have symptoms of acute target organ damage include heart failure, coronary syndromes, renal failure, dissecting aneurysm, hypertensive encephalopathy and stroke.

Causes of severe hypertension

  • Renal parenchymal disease is disorders that involve abnormal permeability to protein and other macromolecules, such as chronic pyelonephritis (bacterial infection of the kidneys), Primary glomerulonephritis or Tubulointerstitial nephritis (characterized by abnormal tubular function results in abnormal urine composition and concentration).
  • The systemic disorder affects some organs and tissues or affects the body as a whole with renal involvement. These include lupus erythematosus (a person's immune system attacks and injures own organs and tissues), systemic sclerosis (a rare disorder causing thickening and scarring of multiple organ systems) or vasculitides (inflammation of a blood vessel or blood vessels).
  • Renovascular is a condition affecting the blood vessels of the kidney, such as atherosclerotic (buildup of a plaque in the blood vessels) disease, fibromuscular dysplasia (narrowing of arteries of kidneys, brain, or abdomen) or polyarteritis nodosa (nodules may block the artery).
  • Endocrine are glands that secrete hormones or other products directly into the blood; gland disorders such as Pheochromocytoma (a small vascular tumor of the adrenal medulla), Conn syndrome (primary hyperaldosteronism) or Cushing syndrome (endocrine hormone disorder).
  • Drug abuses such as Cocaine, Amphetamines, Cyclosporin, Clonidine withdrawal or Phencyclidine.

The most common cause of severe hypertension is still longstanding poorly controlled essential hypertension.

Patients are then categorizing as having asymptomatic severe hypertension, hypertension-urgency, and hypertensive emergency.

Severe hypertension treatment

The goal of treatment is to reduce blood pressure in control, a predictable and safe way to avoid acute coronary, cerebral or renal ischemia (already present then avoid its aggravation).

If you have newly diagnosed as asymptomatic severe hypertension, then you need to admit to the hospital for treatment. If you are already in treatment, require reviewing the treatment for improvement.

If you are, diagnose as hypertensive urgency without overt organ failure. You need to admit to the hospital, repeat BP measurement after 30 minutes of bed rest. The aim of initial treatment should be to lower your blood pressure by 25 % in 24 hours, but not lower than 160/90 mmHg.

If you are diagnosed as a hypertensive emergency with complications such as heart failure, coronary syndromes, hypertensive-encephalopathy, dissecting aneurysm, subarachnoid hemorrhage, and acute renal failure. It may occur with BP over 180/110 mmHg, specifically if the blood pressure has risen suddenly. You need to admit to the hospital and reduce 25 percent BP over 3 to 12 hours, but not lower than 160/90 mmHg. Parenteral drugs most effectively achieve it.

Drugs used for the treatment of hypertensive emergencies are sodium nitroprusside, Labetalol, Nitrates, Hydralazine, Nicardipine, and Esmolol.

Rapid reduction of BP in the case of asymptomatic severe hypertension or hypertensive-urgencies should avoid as it may cause an event of an ischemic attack.

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