Hypertensive crisis: What are the symptoms?

    What's a hypertensive crisis? If I have a spike in my blood pressure, what should I do?

    A hypertensive crisis is a sudden, severe increase in blood pressure. The blood pressure reading is 180/120 millimeters of mercury (mm Hg) or greater. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke or other life-threatening health problems. Seek emergency medical help for anyone with these blood pressure numbers.

    Severely high blood pressure can damage blood vessels and body organs, including the:

    • Heart.
    • Brain.
    • Kidneys.
    • Eyes.

    During a hypertensive crisis, the heart may not be able to pump blood as well as it should.

    There are two types of hypertensive crises.

    • Urgent hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There are no signs of organ damage.
    • Emergency hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There is life-threatening damage to the body's organs.

    Causes of a hypertensive crisis include:

    • Forgetting to take blood pressure medicine.
    • Suddenly stopping certain heart medicines, including beta blockers.
    • Medicine interactions.
    • Tumor of the adrenal gland, called a pheochromocytoma.

    Symptoms of a hypertensive crisis may include:

    • Anxiety.
    • Blurred vision.
    • Chest pain.
    • Confusion.
    • Nausea and vomiting.
    • Not responding to stimulation, called unresponsiveness.
    • Seizures.
    • Severe headache.
    • Shortness of breath.

    If you get a very high blood pressure reading at home and don't have any symptoms, relax for a few minutes. Then check your blood pressure again. If it's still very high, seek medical care.

    Call 911 or emergency medical services if your blood pressure is 180/120 mm Hg or greater and you have chest pain, shortness of breath, or symptoms of stroke. Stroke symptoms include:

    • Numbness or tingling.
    • Loss of feeling in the face, arm or leg, often on just one side of the body.
    • Trouble walking.
    • Trouble speaking.
    • Changes in vision.

    Treatment for a hypertensive crisis may include a hospital stay to watch for organ damage. Medicines to lower blood pressure are given by mouth or IV.

    1. Hypertensive crisis: When you should call 911 for high blood pressure. American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/hypertensive-crisis-when-you-should-call-911-for-high-blood-pressure. Accessed June 13, 2022.
    2. Ferri FF. Hypertension. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed July 15, 2022.
    3. Elliott WJ. Evaluation and treatment of hypertensive emergencies in adults. https://www.uptodate.com/contents/search. Accessed June 14, 2022.
    4. Varon J, et al. Management of severe asymptomatic hypertension (hypertensive urgencies) in adults. https://www.uptodate.com/contents/search. Accessed June 14, 2022.
    5. Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; doi:10.1161/HYP.0000000000000065.
    6. Medical review (expert opinion). Mayo Clinic. July 6, 2022.
    7. Benenson I, et al. Risk factors for hypertensive crisis in adult patients: A systematic review. JBI Evidence Synthesis. 2021; doi:10.11124/JBIES-20-00243.

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