High blood pressure, also known as hypertension, occurs when the force of blood pushing against blood vessel walls is consistently too high. This condition often develops without noticeable symptoms, earning it the nickname “silent killer.” Understanding when severely elevated blood pressure requires immediate medical attention is important to prevent serious health complications and organ damage.
Understanding Blood Pressure Readings
Blood pressure measurements consist of two numbers: systolic (the top number) and diastolic (the bottom number). Systolic pressure represents the force in arteries when the heart contracts and pumps blood. Diastolic pressure indicates the force when the heart rests between beats. Both are expressed in millimeters of mercury (mm Hg).
Blood pressure readings are categorized to help assess risk and guide management. A normal blood pressure is less than 120/80 mm Hg. Elevated blood pressure ranges from a systolic pressure of 120-129 mm Hg and a diastolic pressure less than 80 mm Hg.
Hypertension is further divided into stages. Stage 1 is defined as a systolic pressure between 130-139 mm Hg or a diastolic pressure between 80-89 mm Hg. Stage 2 occurs when the systolic pressure is 140 mm Hg or higher, or the diastolic pressure is 90 mm Hg or higher. A reading of 180/120 mm Hg or higher is a hypertensive crisis, demanding immediate medical evaluation. While a single high reading may not signal an emergency, consistent elevated readings warrant consultation with a healthcare professional.
Recognizing a Hypertensive Crisis: When to Seek Emergency Care
A hypertensive crisis is a sudden and severe increase in blood pressure, typically measuring 180/120 mm Hg or higher. Within this category, it is important to distinguish between a hypertensive urgency and a hypertensive emergency. Both involve very high blood pressure, but a hypertensive emergency also includes evidence of new or worsening organ damage.
Hypertensive urgency refers to a blood pressure reading of 180/120 mm Hg or higher without signs of acute organ damage. Symptoms might be absent, or they could include mild headache, anxiety, nosebleeds, or shortness of breath. If experiencing such high readings without signs of organ damage, contact a doctor promptly for guidance, as rapid lowering of blood pressure in these cases is generally not recommended and can be harmful.
A hypertensive emergency is a medical crisis requiring immediate action. It occurs when blood pressure is 180/120 mm Hg or higher with evidence of organ damage to the brain, heart, kidneys, or eyes. Symptoms are severe and require immediate medical attention, often by calling 911. These include severe headache, chest pain, or shortness of breath.
Signs of organ involvement in a hypertensive emergency include vision changes (blurred vision or loss of vision), sudden weakness or numbness, and difficulty speaking (indicating a stroke). Other concerning symptoms are confusion, nausea, vomiting, seizures, decreased urine output, or blood in the urine (suggesting kidney damage). If these symptoms accompany severely elevated blood pressure, seek immediate emergency medical care to prevent irreversible organ damage.
What to Expect During an ER Visit for High Blood Pressure
Upon arrival at the emergency room for high blood pressure, medical professionals conduct an initial assessment. This involves taking vital signs, including repeated blood pressure measurements, and gathering a detailed medical history, including current medications. A focus will be on identifying any symptoms of organ damage.
Diagnostic tests evaluate blood pressure’s impact on the body. These may include blood tests for kidney function and electrolytes, and an electrocardiogram (ECG) for heart activity. Depending on symptoms, imaging tests like a chest X-ray or head CT scan might be necessary to check for damage to the lungs, brain, or other organs.
Treatment focuses on carefully and progressively lowering blood pressure using intravenous (IV) medications. The specific medication and reduction rate depend on the patient’s condition and affected organs. Common IV medications include labetalol, nicardipine, and clevidipine. The goal is to reduce blood pressure enough to stop further organ damage without lowering it too quickly, which could be harmful. After stabilization, patients may be admitted for continued monitoring, especially if organ damage is identified, or discharged with instructions for follow-up care with their primary healthcare provider.