Hypertensive Crisis: When Should You Go to the ER for High Blood Pressure?
Key takeaways:
A hypertensive crisis occurs when someone’s blood pressure is so high that it threatens or causes organ damage.
You should go to the ER for high blood pressure when it’s also causing symptoms. Examples include headaches, vision changes, confusion, chest pain, trouble breathing, and nausea.
You’re more likely to have symptoms with high blood pressure when the reading goes over 180/120 mmHg. But symptoms can happen at lower blood pressures, too. This is why paying attention to your symptoms is just as important as knowing your blood pressure reading.
Many people know how high blood pressure can lead to health problems over time, like heart disease and stroke. But what about sudden spikes in your blood pressure?
A hypertensive crisis is when your blood pressure is so high that it can cause immediate damage to organs, like the brain, heart, and kidneys. And, if you’re having symptoms of organ damage, this is when high blood pressure is a true emergency. We’ll explain how to know if this is happening to you and when you should go to the ER.
How to know if you’re having a hypertensive crisis
If you’re wondering what to do when your blood pressure is high, there are two questions to ask:
What’s your blood pressure?
Are you experiencing any new symptoms?
Some numbers are certainly too high to be safe, whether or not you’re experiencing any symptoms. But even if your numbers don’t seem that high, it’s still concerning when high blood pressure causes new symptoms. Everyone is different, and people will start to experience symptoms from their high blood pressure at different levels. This is why both the actual number and the way you feel are both important.
Step 1: Is your blood pressure too high?
The way you measure your blood pressure is very important. Otherwise, your blood pressure cuff may give you an incorrect reading. To make sure you get the most accurate number possible:
Use an automated and validated blood pressure device. These devices have been tested for their accuracy.
Rest for at least 5 minutes before taking your blood pressure.
Remove any clothing on the upper part of your arm before taking your pressure.
Measure your blood pressure around the top part of your arm. The cuff size should cover about 80% of the area from your elbow to your shoulder.
While taking your blood pressure, sit quietly in a chair with your feet flat on the floor and your arm at chest level.
How high is too high? Even if you aren’t having an emergency, it’s important to know when to see a healthcare professional for high blood pressure numbers.
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What does high blood pressure feel like? People share their experiences of what high blood pressure felt like to them.
Normal blood pressure is 120/80 mmHg. Any reading above either number is high. But your blood pressure is too high if it exceeds 180/120 mmHg.
If you feel fine despite your high blood pressure, it still requires a call and expedited visit to your primary care provider. They’ll often make some quick adjustments to your medication to try and get your number down. But if they can’t see you soon enough, they may ask you to go to the ER to be safe.
It’s important to know that sometimes people with blood pressure readings lower than 180/120 mmHg should go to the ER as soon as possible to get treatment. This is why the second question is so crucial.
Step 2: Are you experiencing symptoms of a hypertensive crisis?
A hypertensive crisis becomes a true emergency if you’re experiencing any of the symptoms below:
Severe headache: During a spike in blood pressure, the pressure builds up within the skull. This type of headache will usually feel more severe than typical, everyday headaches.
Confusion: High pressure in the brain can also lead to a change in mental status. This can sometimes just look like mild confusion. So, if you or someone you know seems a little off, this might be a medical emergency.
Stroke symptoms: Severe high blood pressure can lead to a stroke. Stroke symptoms include sudden weakness or numbness (often on one side of the body), sudden confusion, trouble seeing, slurred speech, or difficulty getting words out. Regardless of your blood pressure reading, you should call 911 for any of these symptoms.
Change in consciousness: A hypertensive crisis can also change someone’s level of alertness, making them seem excessively sleepy. In severe cases, they may even pass out or have a seizure.
Blurred vision: Even if you aren’t having a stroke, high blood pressure can still damage the blood vessels that supply the eyes. This can cause blurry vision.
Chest pain: The chest pain in a hypertensive crisis is typically severe. It’s usually not related to chest movement or food intake.
Trouble breathing: A hypertensive crisis can lead to heart failure, which can cause fluid to build up in the lungs. This can cause shortness of breath, particularly with exertion or lying flat.
Nausea or vomiting: Nausea is sometimes the first sign of changing blood flow in the body. Even if you don’t have any pain, you should get checked out if you feel like you’re about to vomit.
Severe anxiety: Having high blood pressure can trigger feelings of anxiety. Some people may have a fast heart rate or a sense of impending doom.
If you think you may be experiencing these symptoms, don’t wait to see if they go away or get worse. Head to the ER, where they can help you figure out if you’re having a hypertensive crisis.
What will the ER do for a hypertensive crisis?
If you go to the ER for a hypertensive crisis, your healthcare team will have three main goals:
Figure out why your blood pressure is high.
Check if you have organ damage.
Safely lower your blood pressure.
To figure out the cause — and effects — of your blood pressure, your healthcare team may run some tests. This will be different for everyone, but it can include:
An electrocardiogram (ECG) of your heart
A chest X-ray to look at your lungs
A computed tomography (CT) scan to get a closer look at your heart, lungs, or blood vessels
An echocardiogram (an ultrasound of the heart that evaluates heart function)
Labs and urine tests to help figure out if your kidneys have been affected
What treatment will the ER provide for a hypertensive crisis?
Your ER team will likely give you medications to safely lower your blood pressure. You can take some of these by mouth. And they may just be higher doses of the medications you take at home. But some medications need an intravenous (IV) line.
Some people can safely go home after their ER visit when their blood pressure is lower. Other people may need to stay in the hospital for a short period of time. This is particularly true if testing shows signs of organ damage or if your blood pressure isn’t well managed after treatment in the ER.
What is the difference between a hypertensive crisis and high blood pressure?
A hypertensive crisis is different from just having a high blood pressure reading. High blood pressure is any blood pressure over 130/80 mmHg. When someone has persistently high numbers, they’re usually diagnosed with high blood pressure (hypertension) and start taking medication for it.
A hypertensive crisis means that someone’s high blood pressure falls into one of these categories:
Severe hypertension: This is when someone’s blood pressure is dangerously high (over 180/120 mmHg), but they don’t have signs of organ damage. This needs quick treatment — usually within 1 week — to prevent progression to a hypertensive emergency.
Hypertensive emergency: This is when high blood pressure causes organ dysfunction. This level of high blood pressure is defined by the presence of organ damage, not the actual number. Still, blood pressure is usually in the severe hypertension range.
But don’t worry too much about the technical definitions. These terms help healthcare professionals diagnose and respond to different levels of high blood pressure emergencies. The most important thing to know is that a high blood pressure plus symptoms requires immediate medical care.
What can cause a hypertensive crisis?
Sometimes there’s no apparent cause for spikes in blood pressure. But the following can increase your risk of having a hypertensive crisis:
Stopping your medications: People who suddenly stop blood pressure medications may have spikes in blood pressure. This can also happen with missed doses. These sudden spikes are especially common in people taking beta blockers or clonidine.
Starting new medications: There are many medications that can potentially increase your blood pressure, like nonsteroidal anti-inflammatory (NSAID) medications and some cold and cough medications.
Recreational drug use: Nicotine, methamphetamines, and cocaine are the most common drugs that lead to heart damage and hypertensive crisis.
Pregnancy: Many people have blood pressure issues for the first time while pregnant. In pregnancy, the cutoff for a hypertensive emergency is lower (anything above 160/110 mmHg).
Stress: The link between a hypertensive crisis and stress needs to be studied more. Still, studies have linked anxiety to hypertension, probably due to a brief increase in some hormones.
Even without any of the above circumstances or other medical problems, your blood pressure might increase over time. A hypertensive crisis can happen with the natural progression of hypertension.
How can you prevent a hypertensive crisis from happening?
You can lower your risk of a hypertensive crisis. These steps can help you avoid dangerously high blood pressure:
Take your medications. Take your blood pressure medications as prescribed. To help you remember your medications, consider using strategies like pill counters or phone reminders.
Don’t abruptly stop medications. If any of your blood pressure medications have side effects that you don’t like, talk with your healthcare team so you can try a different medication. This is safer than abruptly stopping a medication.
Get guidance. Talk with your healthcare team and your pharmacist before starting new medications.
Go for regular checkups. This way you’ll know if your blood pressure is slowly creeping up. A healthcare professional can help with lifestyle changes and medications to keep it in check.
Try the DASH diet. DASH stands for “dietary approaches to stop hypertension.” Studies show this eating plan helps lower blood pressure.
If you’ve had a hypertensive emergency in the past, you’re not necessarily more likely to have one in the future. The critical thing is ongoing management of your blood pressure.
The bottom line
A hypertensive crisis happens when your blood pressure is so high that it puts you at risk for organ damage. There’s no magic number to tell when this might happen. That’s why it’s important to know the symptoms. If your blood pressure is high and you’re not feeling well, don’t risk it.
Go to the ER if you have a blood pressure of more than 180/120 mmHg and any of the symptoms we discussed in this article. But, even without symptoms, don’t ignore high blood pressure readings. Call your healthcare team to make sure your treatment is working for you.
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References
Alley, W., et al. Hypertensive Emergency. (2023). StatPearls.
Pan, Y., et al. (2015). Association between anxiety and hypertension: A systematic review and meta-analysis of epidemiological studies. Neuropsychiatric Disease and Treatment.
Validated Device Listing. (n.d.). Blood pressure devices you can trust. American Medical Association.
Whelton, P. K., et al. (2017). 2017 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. American College of Cardiology.
