A blood pressure reading of 198/98 mmHg indicates a severe elevation that demands immediate attention. Blood pressure is measured in millimeters of mercury (mmHg) and consists of two numbers. The first number, 198, is the systolic pressure, which measures the force in your arteries when your heart beats. The second number, 98, is the diastolic pressure, reflecting the pressure in your arteries when your heart rests between beats. This reading is substantially higher than a healthy range, typically below 120/80 mmHg.
Immediate Action Required
A blood pressure reading of 198/98 mmHg indicates a severe elevation, considered a hypertensive crisis, demanding immediate emergency medical attention. Call emergency services, such as 911, or proceed to the nearest emergency room. Waiting to see if the blood pressure decreases on its own is not advisable.
Immediate action is necessary because such extremely high readings can lead to severe organ damage if left unaddressed. Symptoms like chest pain, shortness of breath, a severe headache, vision changes, difficulty speaking, dizziness, or numbness and weakness can indicate that organ damage is already occurring. Even without these symptoms, a reading of 198/98 mmHg warrants prompt medical intervention to prevent life-threatening complications.
Understanding Hypertensive Crisis
A blood pressure reading of 198/98 mmHg falls into the category of a “hypertensive crisis,” defined as blood pressure at or above 180/120 mmHg. Medical professionals differentiate between a hypertensive urgency and a hypertensive emergency. The distinction hinges on the presence or absence of acute target organ damage.
A hypertensive urgency involves very high blood pressure without signs of new or worsening organ damage. It allows for a more gradual reduction in blood pressure, often managed with oral medications in an outpatient setting. Conversely, a hypertensive emergency is defined by severely elevated blood pressure accompanied by evidence of acute organ damage. In such cases, blood pressure must be lowered immediately, usually in a hospital setting, to prevent irreversible harm to organs like the brain, heart, or kidneys.
Common Causes and Risk Factors
Various factors can contribute to a dangerously high blood pressure reading like 198/98 mmHg. The most common cause is often poorly controlled existing hypertension, particularly when individuals do not adhere to their prescribed medication regimens. Suddenly stopping blood pressure medications can also lead to a rebound effect, causing a sharp increase in blood pressure.
Certain underlying medical conditions can trigger a hypertensive crisis. These include kidney disease, endocrine issues such as pheochromocytoma (a rare adrenal gland tumor), or thyroid problems. Pregnancy-related conditions like preeclampsia and eclampsia are also known to cause severe hypertension. The use of certain substances, including illicit drugs like cocaine or amphetamines, and some medications such as steroids, decongestants, or certain antidepressants, can also precipitate a hypertensive crisis. Acute stress, pain, and anxiety can activate the sympathetic nervous system, further contributing to elevated blood pressure.
Medical Treatment and Management
When a patient presents with a hypertensive crisis, medical professionals prioritize a controlled reduction of blood pressure to prevent further organ damage. Treatment typically begins in an emergency room setting, often involving intravenous (IV) medications to lower blood pressure gradually and safely. Common IV medications used include labetalol, nicardipine, clevidipine, and nitroprusside, chosen based on the patient’s specific clinical condition and any signs of organ involvement. The goal is usually to reduce the mean arterial pressure by about 20% to 25% within the first hour or two, rather than immediately normalizing blood pressure, to avoid complications from a too-rapid decrease.
Following initial stabilization, diagnostic tests are performed to assess for any organ damage, which may include blood tests for kidney function, an electrocardiogram to check heart activity, or imaging like a CT scan of the head if neurological symptoms are present. Identifying and addressing the underlying cause of the crisis is also a significant part of the management plan. Once the immediate crisis is resolved, long-term management strategies for hypertension are implemented, which often involve adjusting oral medications and emphasizing lifestyle changes such as dietary modifications, increased physical activity, and weight management.
Potential Complications
Leaving a blood pressure reading of 198/98 mmHg untreated or inadequately managed can lead to severe and potentially irreversible health consequences. The sustained high pressure can damage the delicate lining of blood vessels throughout the body, impairing blood flow to vital organs. This damage can manifest in various life-threatening complications:
- The brain is particularly vulnerable, with risks including stroke due to blood clots or bleeding, and hypertensive encephalopathy, a condition causing temporary brain dysfunction.
- The heart can suffer a heart attack, develop acute heart failure, or experience an aortic dissection, a tear in the body’s largest artery.
- Kidneys may experience acute kidney injury or progress to kidney failure.
- The eyes can be affected, leading to vision loss or hypertensive retinopathy.