An Overview of Hypertensive Emergency

The dangers of this rare but serious form of high blood pressure

doctor checking patient's blood pressure

Katrina Wittkamp/Getty Images

Hypertensive emergency, also known as malignant hypertension, is a serious form of high blood pressure that causes damage to one or more organ systems. While rare—affecting only around 1 percent of people with a history of high blood pressure—hypertensive emergency can cause irreversible organ damage and even death if not treated immediately.

When a person's blood pressure is over 180/120 without evidence of organ damage, it is called hypertensive urgency. In these cases, the doctor will take steps to substantially reduce the blood pressure over a period of hours to days. On the other hand, if similarly elevated blood pressure is accompanied by evidence of organ damage, that's a hypertensive emergency. Immediate hospitalization is required to rapidly reduce the blood pressure and prevent further damage.

While all major organ systems are at risk of injury in a hypertensive emergency, the kidneys, eyes, brain, and heart are the most prone to damage. This form of hypertension develops rapidly, causing the rupture of smaller blood vessels throughout the body.


Because hypertensive emergency affects the organs most sensitive to blood pressure changes, the symptoms are largely dependent on the location of the vascular injury. Some of the more common signs include:

  • Blurry vision
  • Headache
  • Chest pain 
  • Irregular heartbeat
  • Nosebleed
  • Shortness of breath
  • Tingling, numbness, burning, or prickly skin sensations
  • Faintness or dizziness
  • Reduced urine output
  • Nausea or vomiting
  • Altered mental state
  • Burst retinal capillaries
  • Seizures

While these symptoms are not exclusive to hypertensive emergency, they are associated with a number of potentially serious conditions like heart attack, stroke, or kidney failure. For this reason alone, symptoms like these should never be ignored.


The causes of hypertension emergency are not well understood. In many cases, it appears to be the result of multiple contributing factors. Among them:

While a history of high blood pressure is considered central to the risk, other, entirely unrelated factors can trigger an episode. These include the use of illegal drugs (such as cocaine or methamphetamine), birth control pills, head trauma, and spinal cord injuries. Certain over-the-counter drugs, such as antihistamines and cough syrups, can also increase blood pressure in some people.

Some of these factors may account for the fact that younger people are more prone to hypertensive emergency than older adults. By contrast, older adults are more likely to be on anti-hypertensive drugs, thereby reducing their risk.


The diagnosis of hypertensive emergency is made by taking the person’s blood pressure. The doctor will also want to know your medical history and any medications you are taking. If you are diagnosed with hypertensive emergency, you will most likely be immediately admitted to the hospital for close observation and treatment. Depending on how serious the event is, admission to intensive care may be needed.


Intravenous drugs will be used to gradually reduce blood pressure, including sodium nitroprusside and nitroglycerin. Kidney, brain, and heart function may also be closely monitored to assess any irregularities that require emergency intervention. In extreme cases, bloodletting may be used if the intravenous drugs are not working fast enough.

Once stabilized, imaging tests may be ordered to check for any significant bleeding or injury. These may include ultrasound, a computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Once the person is stabilized enough to be released, anti-hypertensive drugs such as beta blockers or ACE inhibitors may be prescribed if they haven’t already been.

A Word From Verywell

If you have been told you have high blood pressure, it's important to follow your doctor's instructions. Blood pressure can usually be well-controlled with lifestyle measures, such as exercise and avoiding obesity, and prescription medications, which you should take as directed. If you experience any of the symptoms of hypertensive emergency, call your doctor or go to the emergency room immediately.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Deshmukh A, Kumar G, Kumar N, et al. Effect of Joint National Committee VII report on hospitalizations for hypertensive emergencies in the United States. Am J Cardiol. 2011;108(9):1277-82. doi:10.1016/j.amjcard.2011.06.046

  2. Kessler, C. and Joudeh, Y. Evaluation and Treatment of Severe Asymptomatic Hypertension. American Family Physician. 2010; 81(4):470-476.

  3. Aronow WS. Treatment of hypertensive emergencies. Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34

Additional Reading