High blood pressure is a chronic condition, and the damage it causes to blood vessels and organs generally occurs over years.
However, it is possible for blood pressure to rise quickly and severely enough to be considered a hypertensive crisis. To reduce morbidity and mortality in this situation, early evaluation of organ function and blood pressure elevations at these levels is critical to determine the appropriate management.
Hypertensive crises can present as hypertensive urgency or as a hypertensive emergency.
If, while monitoring your blood pressure, you get a systolic reading of 180 mm Hg or higher OR a diastolic reading of 110 mm HG or higher, wait a couple of minutes and take it again. If the reading is still at or above that level, you should seek immediate emergency medical treatment for a hypertensive crisis. If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away.
Hypertensive urgency is a situation where the blood pressure is severely elevated [180 or higher for your systolic pressure (top number) or 110 or higher for your diastolic pressure (bottom number)], but there is no associated organ damage. Those experiencing hypertensive urgency may or may not experience one or more of these symptoms:
Treatment of hypertensive urgency generally requires readjustment and/or additional dosing of oral medications, but most often does not necessitate hospitalization for rapid blood pressure reduction. A blood pressure reading of 180/110 or greater requires immediate evaluation, because early evaluation of organ function and blood pressure elevations at these levels is critical to determine the appropriate management.
A hypertensive emergency exists when blood pressure reaches levels that are damaging organs. Hypertensive emergencies generally occur at blood pressure levels exceeding 180 systolic OR 120 diastolic, but can occur at even lower levels in patients whose blood pressure had not been previously high.
The consequences of uncontrolled blood pressure in this range can be severe and include
- Loss of consciousness
- Memory loss
- Heart attack
- Damage to the eyes and kidneys
- Loss of kidney function
- Aortic dissection
- Angina (unstable chest pain)
- Pulmonary edema (fluid backup in the lungs)
If you get a blood pressure reading of 180 or higher on top or 110 or higher on the bottom, and are having any symptoms of possible organ damage (chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking) do not wait to see if your pressure comes down on its own. Seek emergency medical assistance immediately. Call 9-1-1. If you can't access the emergency medical services (EMS), have someone drive you to the hospital immediately.
This content was last reviewed on 08/04/2014.