- [Voiceover] Usually if you have hypertension,
your blood pressure gets higher and higher
over the course of several years even.
And this slow rise also slowly causes complications.
But because it's happening so slowly,
there usually aren't any symptoms directly caused
by high blood pressure.
It is possible though that your blood pressure could rise
quickly and severely enough to be what we call
a hypertensive crisis.
And actually there are essentially two categories
of hypertensive crises.
And the first is hypertensive urgency,
and the other is hypertensive emergency.
Let's just go over urgency first.
So this hypertensive urgency is defined as the situation
where your blood pressure is super elevated,
but there's no acute or sudden damage
to any of your target organs like your kidneys,
your heart, or your brain.
How high are we talkin' though?
Well in general, it'd be above about 180 millimeters
of mercury on the systolic side
or above about 110 millimeters of mercury
on the diastolic side.
So it's like the blood pressure goes up super high
and really fast, but none of those target organs
get hit, right.
But even though these organs aren't damaged,
there can be symptoms associated with hypertensive urgency
like a severe headache or shortness of breath,
nosebleeds, and severe anxiety.
This type of crisis, though, can usually be managed
using some type of oral antihypertensive medication
in an outpatient or a same day sort
of observational setting.
So urgency means no damage, right.
We can probably take a guess
as to what hypertensive emergency is then, huh.
An emergency is when blood pressure is so high
that it's reached levels that damage target organs.
Sometimes this is also referred
to as malignant hypertension.
During one of these hypertensive emergencies,
systolic blood pressure might increase
above 180 millimeters of mercury,
while diastolic might be above 120 millimeters of mercury,
but it can also happen at lower pressures in patients
whose bodies maybe aren't as used to higher blood pressures.
Because target organs can be damaged,
the consequences of hypertensive emergency
are very, very serious and can have severe
and permanent effects on the brain, heart, and kidneys.
Some signs and symptoms of these emergencies
can include chest pain, shortness of breath,
back pain, numbness and weakness, change in vision,
and difficulty speaking.
One example of a serious complication that can happen
to your head and your brain is called encephalopathy,
where enceph means brain
and pathy means disease.
And this is when during a hypertensive emergency,
your extremely high arterial pressure causes
your cerebral arterials, which are like these small arteries
in your brain, to lose their ability to regulate blood flow
in the cerebral capillaries,
which are even smaller blood vessels in your brain.
As pressure goes up and up, fluid or blood essentially leaks
out into the interstitial space causing cerebral edema
or fluid buildup, which also causes an increased pressure
in the skull and eventually brain dysfunction.
Due to the severity of encephalopathy
and other target organ complications,
speedy treatment is extremely important,
so much so that IV or intravenous medications
are used instead of oral medications,
basically to get the drugs into the bloodstream
and working as quickly as possible.
An IV vasodilators, IV calcium channel blocker,
or IV beta blocker might be given.
Each of these helps the arteries and the arterials relax.
Whichever one is used, the goal is always the same:
to safely reduce the blood pressure before the pressure
causes serious and irreversible damage to a target organ.
Since hypertensive emergency tends to be
quite a bit more serious than hypertensive urgency,
it's usually gonna be managed in an intensive care unit
or other closely-monitored setting.