Hypertensive crisis: when is high blood pressure an emergency?

Hypertension is considered an emergency when there are symptoms like severe headache, blurred vision, chest pain, and difficulty in breathing, blood in the urine, or no urine output for more than 12 hours.

Hypertensive crisis has two main entities. The hypertensive emergency and hypertensive urgency.

Hypertensive emergency vs hypertensive urgency

Hypertensive emergency is blood pressure more than 180/120 mmHg associated with organ failure. That means high blood pressure causes damage to one or multiple organs in the body. Following symptoms are considered as emergencies with high blood pressure.

  1. Severe headache
  2. Seizures
  3. Body weakness or numbness
  4. Blurred vision or loss of vision
  5. Chest pain
  6. Severe back pain which not resoled to simple analgesics
  7. Difficulty in breathing
  8. Haematuria or blood in the urine
  9. No urine output for more than 12 hours

When blood pressure is more than 180/120 mmHg mainly the brain, eyes, heart, kidneys, and aorta can get damaged. This occurs because of the damage to the blood vessel wall in individual organs. This is a must-attend to a hospital incident, so it’s better to call 911 if you have the above symptoms with high blood pressure.

A hypertensive emergency can cause very troublesome consequences like,

  • Stroke
  • Permanent loss of vision
  • Cerebral palsy
  • Loss of consciousness
  • Heart attacks
  • Kidney failure
  • Pulmonary edema, a collection of fluid in the lungs
  • Aortic dissection, separation of the walls of the aorta which ultimately causes rupture.

Hypertensive urgency is blood pressure is over 180/120 mmHg without symptoms of organ dysfunction. So there won’t be the above-mentioned symptoms. Even though this isn’t an emergency you should visit a doctor to check your blood pressure accurately. And this is a sign that your blood pressure control is not adequate and it needs to be properly optimized.

Organs damaged in hypertensive emergencies

Emergency treatments for high blood pressure at home?

We do not recommend any medications or hoe remedies at home in a hypertensive emergency. If you didn’t have your blood pressure medications you can take that only in the prescribed dosage, not over that. And you should immediately attend to a hospital. Never take any home remedies or alternative medications in this kind of situation.

Why do hypertensive emergencies happen?

The two main causes of hypertensive emergencies are not taking medications properly and using drugs like cocaine that stimulate the sympathetic nervous system which also contributes to increasing the catecholamines in the body.

What is the level of hypertensive emergency occur?

There are no scientifically proven levels of blood pressure that hypertensive emergencies can occur. Generally this is considered as systolic value ( the higher value ) is more than 180 and diastolic value ( the lower value ) is more than 120.

But if the patient has no history of high blood pressure that type of person can even present with an emergency in lower blood pressure levels. In addition to that chronic hypertensive patients who are adapted to high blood pressure for a long period of time can even get emergencies at much higher levels of blood pressure.

How common are hypertensive emergencies?

30% of the USA population have hypertension. From those 1 to 2% have a hypertensive emergency in any stage of their life. The values are much higher about two decades earlier. But with the new medications, the ready availability of drugs, and improvements of health care facilities to early detection of that type of incidents help to reduce the number of cases

If you have hypertension !

Be prepared. Always keep a record of your blood pressure values and medications. Never forget your blood pressure drugs and do not take cocaine-like drugs that increase your body’s adrenaline levels.

Inform family members and acknowledge them on how to act immediately in an emergency. Because you might not conscious enough to act properly in the situation.

Never underestimate the symptoms even if it is one from the above list. Immediately call 911.

Sources :

  1. Alley WD, Schick MA.(2020).Hypertensive emergency
  2. Heart.org(2017).Hypertensive Crisis: When You Should Call 911 for High Blood Pressure
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Sapumal Edirisinghe
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