From the Guidelines
A hypertensive crisis in a patient taking a monoamine oxidase inhibitor (MAOI) is a life-threatening condition that requires immediate emergency medical attention, and is characterized by symptoms such as severe headache, stiff neck, nausea, vomiting, sweating, dilated pupils, rapid heartbeat, chest pain, confusion, and severely elevated blood pressure (often exceeding 180/120 mmHg) 1.
Key Symptoms
The symptoms of a hypertensive crisis in a patient taking MAOIs may include:
- Severe headache
- Stiff neck
- Nausea
- Vomiting
- Sweating
- Dilated pupils
- Rapid heartbeat
- Chest pain
- Confusion
- Severely elevated blood pressure (often exceeding 180/120 mmHg) These symptoms can occur when MAOIs interact with certain foods containing tyramine (aged cheeses, cured meats, fermented foods) or with medications like decongestants, certain antidepressants, or stimulants 2.
Pathophysiology
The crisis happens because MAOIs block the enzyme that normally breaks down tyramine and other pressor amines, allowing these substances to accumulate and trigger excessive norepinephrine release, causing a sudden, dangerous spike in blood pressure 3.
Management
Patients taking MAOIs should be educated about dietary restrictions and medication interactions, and should seek emergency care immediately if these symptoms develop. Hypertensive emergencies demand immediate reduction of BP (not necessarily to normal) to prevent or limit further target organ damage 2.
Target Organ Damage
Examples of target organ damage include hypertensive encephalopathy, intracerebral hemorrhage (ICH), acute ischemic stroke, acute myocardial infarction (MI), acute left ventricular (LV) failure with pulmonary edema, unstable angina pectoris, dissecting aortic aneurysm, acute renal failure, and eclampsia 2.
From the Research
Symptoms of Hypertensive Crisis in Patients Taking MAOIs
The symptoms that indicate a hypertensive crisis in a patient taking Monoamine Oxidase Inhibitors (MAOIs) include:
- Severe elevation in blood pressure
- Acute target-organ damage
- Headache
- Palpitations
- Chest pain
- Myocardial injury, as evidenced by significant troponin release 4
Causes of Hypertensive Crisis in MAOI Patients
Hypertensive crisis in patients taking MAOIs can be caused by:
- Excessive tyramine intake, typically found in foods such as aged cheeses and meats 4, 5
- Interaction with certain medications, including sympathomimetic and serotonergic drugs 5
- Spontaneous or unprovoked hypertensive crises, although this is a rare phenomenon 6
Treatment of Hypertensive Crisis in MAOI Patients
Treatment of hypertensive crisis in patients taking MAOIs typically involves: