Severe Hypertension

 

Any blood pressure number over 180/110 mmHg is considering as stage-3 hypertension, otherwise known as severe hypertension.

What is a stage-3 severe hypertension?

A severely elevated blood pressure, any blood pressure value more than 180/110 mmHg are considering as stage-3 hypertension, also known as severe hypertension. It is the third stage of hypertension, which is considering as severe and need urgent stringent medical treatment with more frequent monitoring to avoid any hypertension complication.

These patients may present in the following manner:

  • Asymptomatic patient (Neither causing nor exhibiting symptoms of disease)
  • Non-specific symptoms such as headache, dizziness, lethargy
  • 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).
  • Systemic disorder affects a number of organs and tissues, or affects the body as a whole with renal involvement, such as 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 a 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 to review 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. Aim of initial treatment should be to lower your blood pressure by 25 percent in 24 hours, but not lower than 160/90 mmHg.

Oral medications for hypertension urgency

Medication

Dosage

Onset time

Duration

Frequency

Captopril

25 mg

0.5 hours

6 hours

For every 1 to 2 hours

Nifedipine

10 to 20 mg

0.5 hours

3 to 5 hours

For every 1 to 2 hours

Labetalol

200 to 400 mg

2.0 hours

6 hours

For every 4 hours

If you are, diagnose as hypertensive emergency with complications such as heart failure, coronary syndromes, hypertensive-encephalopathy, dissecting aneurysm, subarachnoid hemorrhage and acute renal failure. This 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 case of asymptomatic severe-hypertension or hypertensive-urgencies should avoid as it may cause an event of ischemic attack.