OVERVIEW
A hypertensive subacute is a situation in which blood pressure rises markedly over a short period of time without target organ damage. Hypertensive subemergencies and hypertensive emergencies are collectively referred to as hypertensive crises. Hypertensive subemergencies can mostly be brought down within 24 to 48 h. Oral antihypertensive medications can be used to lower the blood pressure more slowly, so as to avoid lowering the blood pressure too quickly and too low, which can cause insufficient blood supply to the heart, brain, and kidneys, and a decrease in blood flow.
Questions you may be concerned about
What does sub-acute hypertension mean?
Hypertensive subacute is a type of hypertensive crisis, which refers to the clinical manifestation of no rapid deterioration in the function of vital target organs despite a marked increase in blood pressure.
Hypertensive crises are divided into hypertensive emergencies and hypertensive subemergencies, of which emergencies refer to patients with primary or secondary hypertension who, under the effect of certain causative factors, have a sudden and marked increase in blood pressure (generally more than 180/120 mmHg), accompanied by progressive cardiac, cerebral, renal and other important target organ insufficiency.
Sub-emergency hypertension refers to patients with markedly elevated blood pressure, but without rapid deterioration of the function of the important target organs mentioned above, such as no fundus changes or symptoms of damage to the function of the heart, brain, kidneys and other organs. These patients generally do not need emergency intravenous medication, but should be given oral medication immediately for short-term (in days) to effectively control their blood pressure, and closely followed up to prevent transformation into hypertensive emergencies.
Therefore, when a sub-acute case of hypertension occurs, it is also important to seek medical attention in a timely manner and use medication under the guidance of a medical professional to avoid adverse consequences.
Causes
On the basis of primary and secondary hypertension, there are many reasons that can induce hypertensive subacute, such as stress, abnormal nerve reflex, endocrine hormone abnormality, and the sudden discontinuation of anti-hypertensive drugs in hypertensive patients, etc., which can increase sympathetic nerve tone and release vasoconstrictor active substances, inducing a short-term sharp increase in blood pressure.
Symptoms
Rapid onset, significant increase in blood pressure, often dominated by systolic blood pressure increase, headache, dizziness, irritability, nosebleed, palpitation, shortness of breath, excessive sweating, nausea, vomiting, chest pain, pallor or flushing, etc., but not accompanied by hypertensive encephalopathy, intracranial hemorrhage, acute myocardial infarction, acute left heart failure with pulmonary edema, and other target organ damage manifestations.
Examination
1. Vital signs monitoring
Blood pressure is elevated within a short period of time, with elevated systolic blood pressure as the main cause.
2. Laboratory examination
Blood routine, urine routine, coagulation function, blood biochemistry, blood gas analysis, bedside rapid markers of myocardial injury, markers of heart failure, blood glucose, etc. are needed to determine whether there is target organ lesion.
3. Electrocardiogram
It can check whether there are cardiovascular lesions.
4. Imaging
Including echocardiography, chest X-ray, chest CT, head CT, etc., which can identify the presence or absence of related systemic complications.
Diagnosis
The diagnosis can be made by recent significant elevation of blood pressure; higher than normal blood pressure, usually above 180/120 mmHg; usually with symptoms related to elevated blood pressure; and exclusion of acute or progressive cardiac, cerebral, renal, large vessel and other target organ damage.
Treatment
Initial treatment should be combined with rest and observation with immediate oral antihypertensive drugs to gradually reduce blood pressure within 1 to 2 d. Blood pressure should be controlled within a few days. Intravenous or oral rapid antihypertensive drugs should not be used to avoid a sudden drop in blood pressure leading to a decrease in the perfusion pressure of the major organs and serious neurological complications. Patients with severe hypertension need to have the cause identified and treated according to the etiology.
Prognosis
A sudden and excessive drop in blood pressure can lead to neurologic complications, and early rapid blood pressure lowering does not provide long-term control of blood pressure.
Prevention
Patients with hypertension should use medication rationally, avoid inappropriate reduction and discontinuation of medication, so as to avoid triggering subacute hypertension, and improve the awareness and control rate of patients with hypertension, which can effectively prevent its occurrence.