A hypertensive crisis is a sudden spike in blood pressure to 180/120 mmHg or higher, which is a medical emergency that could lead to organ damage or be life-threatening. Symptoms include headaches, confusion, chest pain, nausea, and weakness. Causes include non-compliance with medications, high salt/fat diets, certain drugs, kidney disease, and hormone imbalances. Treatment involves reducing blood pressure in the ICU over hours to days depending on any organ damage present. Nursing care focuses on monitoring, medication administration, lifestyle changes, and education to prevent future crises.

1. Hypertensive crisis
By:
Ahmed Zinhom
PHD in nursing administration. Cairo university
Educator at Alnas hospital

2. What is hypertensive crisis?
•A hypertensive crisis is a sudden spike (acute marked
elevation) in blood pressure to 180/120 or higher. A
normal blood pressure is 119/79 or lower.
•A hypertensive crisis is also known as acute
hypertension.
•This is a medical emergency that could lead to organ
damage or be life-threatening.

3. HTN crisis
HTN emergency
•There is acute organ damage
•Treated in ICU
HTN urgency
•No organ damage
•May be treated in OPD over
hours or days

4. Hypertensive crisis symptoms
1- Head and neurologic symptoms:
• Stroke
• Headache: due to increased pressure in the head or a bleed in the
brain.
• Confusion, agitation, or seizures: Increased pressure in the head,
a bleed in the brain, or decreased blood flow to a part of the brain
causing a stroke can cause confusion, seizures, agitation.
• Numbness weakness: Sudden numbness or weakness in a part of
the body is usually due to decreased blood flow to a part of the
brain causing a stroke.

5. 2- Chest-related symptoms
•Chest pain or discomfort (ACS)
•Pulmonary oedema
•Aortic dissection
•Shortness of breath
3- Stomach and urinary symptoms
•Nausea or vomiting:
•Hematuria .
Hypertensive crisis symptoms (cont.,)

6. Hypertensive crisis causes
• Non compliance to antihypertensive medications
• Eating high salt high fat diet
• Taking certain medications or drugs: such as oral contraceptive pills,
over-the-counter painkillers, and steroids, as well as cocaine or.
• kidney disease: The kidneys are responsible for filtering blood,
producing urine, and maintaining normal blood pressure, so if the
kidneys are not functioning properly
• Having a disease involving imbalanced hormones: including
aldosterone, cortisol, thyroid hormone, parathyroid hormone, or
catecholamines can cause high blood pressure.
Causes of Hypertensive crisis

7. •The 2017 American College of Cardiology/American Heart
Association (ACC/AHA) guidelines recommendations for
hypertensive crises and emergencies include the following:
•Admit adults with a hypertensive emergency to an ICU for
continuous monitoring of BP and target organ damage, as well
as for parenteral administration of an appropriate medication.
•For adults with a compelling condition (ie, aortic dissection,
severe preeclampsia or eclampsia):
- lower SBP to below 140 mm Hg during the first hour
- and to below 120 mm Hg in aortic dissection.
Medical management

8. •The 2017 American College of Cardiology/American Heart
Association (ACC/AHA) guidelines recommendations for
hypertensive crises and emergencies include the following:
•For adults without a compelling condition:
- reduce the SBP to a maximum of 25% within the first hour;
- then, if the patient is clinically stable, lower the BP to 160/100-
110 mm Hg over the next 2-6 hours,
- and then cautiously to normal over the following 24-48 hours.
Medical management (cont.,)

9. The risk
•According to Hypertension Canada guidelines (2020),
HCs are associated with a > 79% increase in the death
rate within 1 year, and when interventions are not made
to lower blood pressure (BP), survival is approximately
11 months.

10. Nursing management
1.Provide oxygen if spo2< 94%.
2.Minimize oxygen demand by maintaining the patient at bed
rest.
3.Complete physical examination, history taking with SAMPLE
technique.
4.Help the patient decrease anxiety, and keep the patient NPO or
provide a liquid diet in the acute phase.
5.Prepare the patient and family for surgical intervention to
correct the underlying cause, if this is indicated.

11. Nursing management (cont.,)
6. Close monitoring for blood pressure, ECG, conscious level
7. Regular assessment for lung crackles.
8. Assessment of kidney function.
9. Bleeding precautions
10. Avoid sudden drop in BP especially if developed stroke.

12. Nursing management (cont.,)
11. Managing the prescribed medications:
The ABCD mnemonic will cover antihypertensive drug classes such as
• Arterial/venous dilators: monitor BP
• Beta (b)-blockers: monitor BP& HR
• Calcium channel blocker: monitor BP, edema, constipation
precautions.
• Diuretics: monitor BP, UOP, electrolytes, CVP, weight.

13. BP regular follow up
Medication compliance
Stress management
Diet: low salt, low fat
Life style modification, smoking cessation
Danger signs: DCL, chest pain, BP above 180 despite treatment
Patient and family education (PFE)