Case: Ms. Guo is 58 years old and has been suffering from hypertension for more than ten years. She usually takes antihypertensive drugs irregularly, often forgets to take medicine, consciously suffers from dizziness and headache, and takes antihypertensive drugs, and rarely measures blood pressure.
Recently, due to overworked households, I had a significant headache, dizziness, and standing when I got up in the morning. I was accompanied by nausea and vomiting. My family rushed to the hospital for treatment. The blood pressure in the hospital reached 210/125mmHg. The doctor diagnosed it as a hypertensive emergency.”, quickly sent to the emergency room for treatment before leaving the danger.
Asked: What is “hypertension emergency”?
Hypertensive emergencies are high blood pressure patients with elevated blood pressure and target organ damage (such as hypertensive encephalopathy, myocardial infarction, unstable angina, pulmonary edema, eclampsia, stroke, etc.) during the development of the disease or under certain incentives.Fatal arterial bleeding or aortic dissection).
The clinical manifestations of hypertensive emergencies include a sharp rise in blood pressure and target organ damage, so the symptoms are complex and diverse.
Common symptoms include headache, dizziness, irritability, nausea, vomiting, palpitations, shortness of breath, and blurred vision.
Target organ damage has a corresponding clinical manifestation depending on different organs.
Hypertension and acute illness are fierce. If the rescue measures are not effective, the patient is prone to death.
With the advancement of medical science, there are many effective antihypertensive drugs. If patients are found in time, effective treatment can be given immediately, which can turn patients into safety.
高血压患者警惕三种急症 广东省第二中医院心血管内科靳利利副主任医师称，气短、气促、气喘的症状，往往是心肺疾病的发病前兆，也就是肺源性气喘和心源Sexual asthma, the former is mostly bronchitis, asthma and other diseases, the latter is more cardiac insufficiency, arrhythmia, the most dangerous is acute left heart failure.
靳利利 said that patients with high blood pressure suddenly have shortness of breath, cyanosis, dyspnea with coughing pink foam, can not be supine, should be alert to acute left heart failure, because the disease is not timely rescue may be life-threatening.
Therefore, hypertensive patients should be alert to three kinds of emergencies: first of all, be alert to signs of cerebral apoplexy such as nausea, vomiting, palpitation, confusion, secondly, chest pain, chest tightness, cold sweat and other symptoms of myocardial infarction, the third should be alert to whether shortness of breath is acute leftThe manifestation of heart failure, once the disease occurs, should quickly let the patient take a sitting position, legs sag, such as an oxygen bag at home, should immediately let the patient oxygen, and immediately notify the emergency center.
Diagnosis of hypertensive emergency 1. Hypertension Blood pressure>140/90mmHg.
When paying attention to blood pressure, the cuff is the same size and tightness, and the position is normal.
At least 2 measurements are taken. If the difference between the two times exceeds 5 mmHg, add another test and take the average of the high values of the two readings.
If the difference in systolic blood pressure between the upper limbs exceeds 20 mmHg, the blood pressure of the extremities should be measured, and whether there is aortic inflammation, constriction or dissection aneurysm.
2, there is no absolute threshold for the rise of blood pressure, where the relative elevation of blood pressure, the important target organ progressive damage, and need emergency treatment, can be diagnosed as hypertension emergency.
“高血压急症”在家如何急救 由于患者及其家属，是发现患者发生高血压急症的第一人，又是可以立即给予其最及时治疗的第一人，因此，家属及病人自己了解高血压急症Therapeutic knowledge is the primary factor determining the prognosis of a patient.
Hypertensive patients should do this when the following conditions occur – the patient’s sudden nausea, vomiting, severe headache, palpitation and even blurred vision, accompanied by a sudden increase in blood pressure, indicating that hypertensive encephalopathy has occurred, should immediately rest in bed, stabilize the patientEmotions, don’t be nervous.
Take antihypertensive drugs in time.
If the condition does not improve after taking the medicine and rest, the emergency center should be notified to the hospital for emergency treatment.
If a hypertensive patient develops symptoms, there are not only headaches, vomiting, but also numbness, paralysis, and disturbance of consciousness. This symptom may be acute cerebrovascular disease.
The family should immediately notify the emergency center and immediately position the patient to the side, tilting the head to one side to prevent vomiting from inhaling the airway, causing aspiration, resulting in asphyxia or aspiration pneumonia.
Hypertensive patients suddenly have short qi, shortness of breath, cyanosis, difficulty breathing, coughing pink foam, and cannot lie flat.
Acute left heart failure may occur, the patient should be quickly placed in a sitting position, and the legs should sag. If an oxygen bag is provided in the home, the patient should be given oxygen immediately and the emergency center should be notified immediately.
Hypertension patients suddenly suffer from precordial pain, chest tightness, and radiation to the left shoulder or left upper limb, pale complexion, and cold sweat after fatigue or mental stimulation. This may be an acute angina or myocardial infarction.
Let the patient rest quietly, take a piece of nitroglycerin under the tongue, and inhale oxygen, call the emergency center immediately.
Classification and treatment of hypertensive emergencies There are two types of hypertensive emergencies. The first category causes acute target organ damage due to a sharp rise in blood pressure. The treatment needs to be depressurized 1 hour after the onset of symptoms to have no serious consequences.
The second category is a hypertensive emergency without acute target organ damage, and its treatment allows blood pressure to be lowered within 24 hours.
If it is not possible to clearly distinguish which category it belongs to, it should be treated as the first category.
When dealing with the first type of hypertensive emergency, the patient should be injected with antihypertensive drugs immediately to lower the blood pressure as soon as possible, but to prevent excessive blood pressure drop. If the excessive decrease exceeds the limit of automatic regulation of the cerebral circulation and the basic perfusion pressure of the heart, it will move towardThe opposite.
It is generally required to reduce the systolic blood pressure according to the blood pressure level before treatment.
7kPa (50 ~ 80mmHg), diastolic blood pressure decreased by 4 ~ 4.
67kPa (30 ~ 50mmHg), is not required to fall to normal levels, generally required slightly higher than normal.
Commonly used drugs are: sodium nitroprusside, add 25-100mg to 5% glucose water 500ml in the dark, stop the drip rate of 10 ~ 25mg per minute, after the blood pressure reaction, increase the infusion rate every 5-10 minutes, untilThe blood pressure drops to a satisfactory level, and it can be used immediately after the use of sodium nitroprusside. After stopping the instillation, the effect disappears within 3-5 minutes; nitroglycerin is added to the suspension of 250-500 ml of glucose water at 5-10 mg for 2-5 minutes.That is to play the antihypertensive effect, began to drip at a rate of 5 ~ 10mg per minute, and then gradually increase the dose according to the blood pressure response; low pressure azole, 50 ~ 150mg intravenous injection; phentolamine, 5 ~ 15mg added 5% glucose water 100ml in the staticDrop; furosemide, 40mg intravenous injection.
In the second type of hypertension treatment, oral medication can generally be used to control blood pressure.
Commonly used drugs are: 25 to 50 mg of captopril orally or sublingually, and can be administered repeatedly when needed;1?
2mg orally, once every hour if necessary; long-pressure oral 10?
20 mg orally or sublingually, can be repeated after 30 minutes.
Preventive measures for hypertensive emergencies Hypertension emergencies should be treated as soon as possible, individualized treatment, overall treatment, long-term treatment, brake recovery function, and reintegration.
To treat hypertensive emergencies, it is best to have no rain and thick sputum, to prevent the main, do not “normally do not burn incense, hurry when holding Buddha feet.”
So how to prevent high blood pressure and high blood pressure emergency?
First, we must seriously change our way of life.
There are statistics, control drinking, quit smoking, and insist on appropriate physical activity (especially regular aerobic activities, such as brisk walking, 4 days a week, more than 30 minutes each time), with a decrease in systolic blood pressure 4?
9 mm Hg;; appropriate salt restriction, 6 grams per day, can reduce systolic blood pressure 2?
8 mm Hg; foods with low fat and saturated fatty acids, vegetables and fruits; people who are overweight or obese lose weight, and maintaining normal body weight is also beneficial for blood pressure reduction.
Paying attention to mental health is not only an important means of treatment for hypertension, but also the basis for intolerance of other cardiovascular diseases and even diabetes treatment.
Hypertensive patients need to seriously and permanently incorporate these measures into their daily routine.
Patients who have taken antihypertensive drugs should go to the hospital regularly, follow the doctor’s prescription, and do not take medicine and stop taking it.