What Is a Hypertensive Crisis?

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A hypertensive crisis occurs when there is a sudden spike in blood pressure to dangerous levels. It is considered a medical emergency, and you should seek out immediate medical attention if you experience extremely high blood pressure.

Blood pressure associated with a hypertensive crisis means the systolic pressure (the top number) is 180 millimeters of mercury (mm Hg) or higher, and the diastolic pressure (the bottom number) is 120 mm Hg or higher. A normal blood pressure for an adult is less than 120/80 mm Hg. 

Blood pressure check
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Hypertensive Crisis Types and Symptoms

A hypertensive crisis is either an urgency or an emergency. A 2014 report in the International Journal of Chronic Diseases finds that hypertensive urgencies account for 76% of hypertensive crises and hypertensive emergencies account for 24%.

Hypertensive Urgency

While hypertensive urgencies are common, major complications associated with them are uncommon. In a hypertensive urgency, blood pressure is extremely high, but your healthcare provider doesn’t believe there is damage to the organs.

Symptoms of a hypertensive urgency include:

Symptoms experienced with hypertensive urgency will depend on how high the blood pressure is.

Hypertensive Emergency

With a hypertensive emergency, blood pressure is extremely high and there has been damage to one or more organs. An emergency hypertensive crisis could also mean life-threatening complications.

Signs and symptoms of a hypertensive emergency include:

  • Severe chest pain
  • Shortness of breath
  • Severe headache
  • Confusion and blurred vision
  • Nausea and vomiting
  • Extreme anxiety
  • Seizure
  • Unresponsiveness

Complications

Any severe increase in blood pressure should be considered a medical emergency and you should seek out urgent medical attention. This is because a hypertensive crisis puts you at risk for a number of life-threatening conditions, including heart attack, stroke, or kidney damage, and any of these can occur even while treating the hypertensive emergency and taking daily medications to maintain blood pressure.

It is possible for people who experience a hypertensive crisis to develop tears in the wall of the aorta—the artery supplying blood throughout the body. This results from increased blood pressure that further adds to the burden of the circulatory system and decreases its effectiveness. Significant increases in blood pressure can also cause fluid to accumulate in the lungs and complicate breathing.

A hypertensive crisis can put you at risk for eye damage, seizures, and brain damage. The eyes and the brain are two of the most vulnerable organs during a hypertensive emergency. Other susceptible organs are the heart and kidneys.

Causes

Hypertensive crises often affect people with a history of high blood pressure, especially those who have blood pressure that is often over 140/90 mm Hg. These crises are also common in Blacks, men, and people who smoke.

Some health conditions and medications can increase a person’s risk for a hypertensive crisis. These may include:

  • Kidney disorders or kidney failure
  • Pregnancy and, specifically, a condition called preeclampsia, which is common after 20 weeks of pregnancy or in some cases, can occur postpartum (after giving birth)
  • Autoimmune diseases—Studies show a strong connection between autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus and hypertension
  • A spinal cord injury that may cause the nervous system to overreact
  • Renal artery stenosis—a condition that causes narrowing of the arteries of the kidney
  • A narrowing of the aorta—the main blood vessel leaving the heart
  • Medications, including birth control pills and monoamine oxidase inhibitors (MAOIs)

Some negative lifestyle factors increase your risk for a hypertensive crisis, such as:

  • Not taking your blood-pressure medicines
  • Cocaine and amphetamine use
  • Cigarette smoking
  • Alcohol abuse

Anyone who has been diagnosed with high blood pressure and develops a blood pressure of 180/120mm Hg or higher should seek emergency medical attention. If you develop changes related to a hypertensive emergency—such as those mentioned above—you should also seek out medical attention, even if your blood pressure is only slightly high.

Diagnosis

A hypertensive crisis is usually diagnosed in an emergency room. Your treating physician will ask about your medical history, perform a physical exam, and order a variety of tests, including lab work, an electrocardiogram, and imaging.

Medical history: A brief history will be taken upon admission to the emergency room. You will be asked about a history of hypertension and medications you take to treat high blood pressure and other conditions. You will also be asked about neurological, renal, and cardiac symptoms to assess for or rule out other emergencies.

Physical examination: A physical exam will focus on blood pressure assessment and determining if there is any organ damage.

Lab work: Bloodwork during a hypertensive crisis is done to assess for other conditions that may be causing your symptoms. Blood and urine tests are often done to find out how well the liver and kidneys are functioning. High blood pressure can cause damage to both organs.

Electrocardiogram (EKG): An EKG is used to monitor the heart and record the heart’s electrical activity to determine if the elevated blood pressure has affected the heart.

Imaging: An X-ray or computerized tomography (CT) scan can help look for signs of stroke, heart failure, and fluid around the lungs and heart.

A diagnosis of a hypertensive urgency or hypertensive emergency can be made based on the presence of extremely high blood pressure and/or findings of organ involvement.

Treatment

A hypertensive crisis can be life-threatening and require immediate medical intervention. You will need immediate treatment in order to slowly lower blood pressure and reduce the risk of dangerous and life-threatening complications. You will likely be admitted to the hospital to bring down blood pressure and treat any problems that have resulted.

Treatment may depend on the cause of the crisis and managing any health condition or medication that has caused it. It may also include blood pressure medicines or antihypertensive drugs, given intravenously (through a vein). By treating a hypertensive crisis in this way, it is addressed quickly.

Once the blood pressure stabilizes, your doctor will prescribe oral blood pressure mediations to control blood pressure at home. Your doctor will also recommend regular checkups to monitor blood pressure and continuing to take your medications regularly.

Bringing down blood pressure as quickly as possible can prevent further organ damage. Treatment for affected organs is managed with therapies specific to the organ that has been damaged.

A Word From Verywell

Some hypertensive crises can be prevented. If you have high blood pressure, you should check your blood pressure regularly. It is also important to take all your prescribed treatments without missing doses. Try to maintain a healthy lifestyle that includes a whole-foods diet, exercise, and not smoking.

Make sure you manage any other health conditions that can put you at risk for a hypertensive crisis. Always seek out immediate medical treatment for extremely high blood pressure and symptoms associated with hypertensive crises. You will need immediate help to reduce or prevent organ damage.

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