Hypertensive Emergency

Overview

What is a hypertensive emergency?

A hypertensive emergency is very high blood pressure that damages the body. It can cause damage to the brain, heart, eyes, or kidneys. A hypertensive emergency needs immediate care.

What are the symptoms?

The symptoms of a hypertensive emergency include headache, chest pain, trouble breathing, numbness, blurry vision, and confusion.

What causes it?

A hypertensive emergency can be caused by many things. These include other health problems, certain medicines, and not taking blood pressure medicines correctly. Another cause of a hypertensive emergency is illegal drug use, such as stimulants like cocaine.

What other health problems can happen when you have a hypertensive emergency?

A hypertensive emergency can cause:

  • Bleeding in your brain or body.
  • Heart attack.
  • Stroke.
  • Heart failure.
  • Kidney failure.
  • Eye damage and loss of vision.

How is it treated?

To treat a hypertensive emergency, doctors and nurses will carefully monitor your blood pressure and give you medicine intravenously (through a needle inserted in one of your veins). The immediate goal is to lower your blood pressure enough so that your organs are no longer in immediate danger. But it must be lowered slowly so that your body has enough time to adjust to the change in blood pressure. If blood pressure is lowered too quickly, your body may have a hard time getting blood to your brain.

The other goal of treatment is to treat organ complications. For example, your doctor may give you a diuretic if you have fluid buildup in your lungs. Or your doctor may give a beta-blocker and nitrates if you have myocardial ischemia (not enough blood is reaching your heart). After your doctor has lowered your blood pressure to a safe level and treated your complications, he or she will try to identify the cause of the acute episode. Your doctor will then work with you to create a treatment regimen that can help prevent future attacks.

When to call a doctor

Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/120.

For example, call 911 if:

  • You have symptoms of a heart attack. These may include:
    • Chest pain or pressure, or a strange feeling in the chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
    • Lightheadedness or sudden weakness.
    • A fast or irregular heartbeat.
  • You have symptoms of a stroke. These may include:
    • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden trouble speaking.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.
  • You have severe back or belly pain.

Do not wait until your blood pressure comes down on its own. Get help right away.

Call your doctor now or seek immediate care if:

  • Your blood pressure is much higher than normal (such as 180/120 or higher), but you don't have symptoms.
  • You think high blood pressure is causing symptoms, such as:
    • Severe headache.
    • Blurry vision.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • Your blood pressure measures higher than your doctor recommends at least 2 times. That means the top number is higher or the bottom number is higher, or both.
  • You think you may be having side effects from your blood pressure medicine.

Related Information

Credits

Current as of: January 10, 2022

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
Robert A. Kloner MD, PhD - Cardiology
Heather Quinn MD - Family Medicine