Blood pressure measures the force of blood against the walls of your arteries. It naturally fluctuates throughout the day due to factors like physical activity, stress, and sleep. While normal variations are not a concern, extremely high readings can signal a serious medical event. Such elevated levels pose significant risks to various organs and often demand immediate medical attention.
Understanding Blood Pressure Readings
Blood pressure measurements consist of two numbers: systolic and diastolic. The systolic pressure, the top number, indicates the pressure when your heart beats and pumps blood. The diastolic pressure, the bottom number, represents the pressure when your heart rests between beats. Both numbers are measured in millimeters of mercury (mmHg).
Blood pressure is categorized into several ranges. A normal reading is less than 120/80 mmHg. Elevated blood pressure is characterized by a systolic reading between 120 and 129 mmHg and a diastolic reading less than 80 mmHg. Hypertension, or high blood pressure, is further divided into stages.
Stage 1 hypertension involves a systolic pressure from 130 to 139 mmHg or a diastolic pressure from 80 to 89 mmHg. Stage 2 hypertension is diagnosed when systolic pressure is 140 mmHg or higher, or diastolic pressure is 90 mmHg or higher. These categories help healthcare providers determine the appropriate course of action, from lifestyle adjustments to medication.
Recognizing a Hypertensive Crisis
A hypertensive crisis is a severe and sudden increase in blood pressure, defined as 180/120 mmHg or higher. This level is a medical emergency that can lead to serious health complications, including heart attack, stroke, or other life-threatening issues if not addressed promptly. When blood pressure reaches this level, seek emergency medical help immediately.
Severe symptoms alongside high readings indicate a hypertensive emergency, requiring an immediate emergency room visit. These symptoms include severe headache, chest pain, or shortness of breath. Other signs are blurred vision, confusion, difficulty speaking, numbness, weakness, nausea, or vomiting. The combination of these symptoms with elevated blood pressure signals a true medical crisis.
Hypertensive Urgency Versus Emergency
Both hypertensive urgency and emergency involve blood pressure readings of 180/120 mmHg or higher. The difference lies in the presence or absence of acute target organ damage. In an emergency, severely elevated blood pressure actively causes new or worsening damage to organs like the brain, heart, kidneys, or eyes. This damage can manifest as severe headache, altered mental status, chest pain, or acute renal failure.
Hypertensive urgency occurs when blood pressure is significantly elevated, but there is no evidence of acute organ damage. While mild headache, anxiety, or a nosebleed might be present, these do not indicate immediate harm. Though not immediately life-threatening, urgency still requires prompt medical attention to prevent progression. In urgency cases, blood pressure can be managed with oral medications and a gradual reduction over hours or days, often in an outpatient setting.
What to Do and Expect
If your blood pressure is 180/120 mmHg or higher, and you experience severe symptoms such as chest pain, shortness of breath, vision changes, or numbness, call 911 or your local emergency services immediately. Do not wait for your blood pressure to decrease on its own. Prompt action is crucial to prevent irreversible organ damage.
Upon arrival at the emergency room for a suspected hypertensive emergency, medical professionals will assess your condition, monitor blood pressure, and conduct tests for organ damage. These tests may include blood tests, urine tests, an electrocardiogram (ECG), or imaging scans. Medications to safely lower blood pressure, often administered intravenously, will be given. The goal is to gradually reduce blood pressure to prevent further complications, with a target of a 20-25% reduction in mean arterial pressure within the first hour or two. Following stabilization, healthcare providers will discuss follow-up care and adjustments to your long-term blood pressure management plan.