What Is a Hypertensive Crisis?

Table of ContentsView AllTable of ContentsTypes and SymptomsCausesDiagnosisTreatment

Table of ContentsView All

View All

Table of Contents

Types and Symptoms

Causes

Diagnosis

Treatment

A hypertensive crisis occurs when there is a sudden spike inblood pressureto dangerous levels. It is considered a medical emergency, and you shouldseek out immediate medical attentionif 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.Verywell / Laura PorterHypertensive Crisis Types and SymptomsA hypertensive crisis is either an urgency or an emergency. A 2014 report in theInternational Journal of Chronic Diseasesfinds that hypertensive urgencies account for 76% of hypertensive crises and hypertensive emergencies account for 24%.Hypertensive UrgencyWhile 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.Most people with hypertensive urgency have no symptoms, but some may experience:HeadacheLightheadednessPalpitationsAnxietySince any of these symptoms may indicate organ damage (and thus a hypertensive emergency), any symptoms associated with a very high blood pressure need to be fully evaluated right away.Hypertensive EmergencyWith 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:Severechest painShortness of breathSevere headacheConfusion and blurred visionNausea and vomitingExtreme anxietySeizureUnresponsiveness9 High Blood Pressure (Hypertension) SymptomsComplicationsAny 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, includingheart 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 theaorta—the artery supplying blood throughout the body. This results from increased blood pressure that further adds to the burden of thecirculatory systemand 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.What Blood Pressure Level Increases Risk of Stroke?CausesHypertensive 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 orkidney failurePregnancy 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 likerheumatoid arthritisandsystemic lupus erythematosusand hypertensionA spinal cord injury that may cause the nervous system to overreactRenal artery stenosis—a condition that causes narrowing of the arteries of the kidneyA narrowing of the aorta—the main blood vessel leaving the heartMedications, 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 medicinesCocaine and amphetamine useCigarette smokingAlcohol abuseAnyone 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.DiagnosisA hypertensive crisis is usually diagnosed in an emergency room.Your treating heatlhcare provider will ask about your medical history, perform a physical exam, and order a variety of tests, including lab work, anelectrocardiogram, 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: AnX-rayorcomputerized 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.How Hypertension Is DiagnosedTreatmentA 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 orantihypertensive drugs, given intravenously (through a vein).By treating a hypertensive crisis in this way, it is addressed quickly.Once the blood pressure stabilizes, your practitioner will prescribe oral blood pressure mediations to control blood pressure at home. Your healthcare provider 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.Natural and Prescription Ways to Lower Hypertension (High Blood Pressure)A Word From VerywellSome 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.Living With Hypertension

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.

Verywell / Laura Porter

Hypertensive Crisis Types and Symptoms

A hypertensive crisis is either an urgency or an emergency. A 2014 report in theInternational Journal of Chronic Diseasesfinds 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.

Most people with hypertensive urgency have no symptoms, but some may experience:

Since any of these symptoms may indicate organ damage (and thus a hypertensive emergency), any symptoms associated with a very high blood pressure need to be fully evaluated right away.

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:

9 High Blood Pressure (Hypertension) Symptoms

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, includingheart 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 theaorta—the artery supplying blood throughout the body. This results from increased blood pressure that further adds to the burden of thecirculatory systemand 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.

What Blood Pressure Level Increases Risk of Stroke?

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:

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

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.

A hypertensive crisis is usually diagnosed in an emergency room.Your treating heatlhcare provider will ask about your medical history, perform a physical exam, and order a variety of tests, including lab work, anelectrocardiogram, 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: AnX-rayorcomputerized 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.

How Hypertension Is Diagnosed

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 orantihypertensive drugs, given intravenously (through a vein).By treating a hypertensive crisis in this way, it is addressed quickly.

Once the blood pressure stabilizes, your practitioner will prescribe oral blood pressure mediations to control blood pressure at home. Your healthcare provider 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.

Natural and Prescription Ways to Lower Hypertension (High Blood Pressure)

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.

Living With Hypertension

8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Salkic S, Batic-Mujanovic O, Ljuca F, et al.Clinical presentation of hypertensive crises in emergency medical services. Mater Sociomed. 2014;26(1):12-16. doi:10.5455/msm.2014.26.12-16Almas A, Ghouse A, Iftikhar AR, et al.Hypertensive crisis, burden, management, and outcome at a tertiary care center in Karachi.International Journal of Chronic Diseases.2014;1–7. doi:10.1155/2014/413071Breu AC, Axon RN.Acute treatment of hypertensive urgency. J Hosp Med. 2018 Dec 1;13(12):860-862. doi:10.12788/jhm.3086Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD.Advances in management of acute hypertension: A concise review.Discov Med. 2012;13(72):375-383.Waldron FA, Benenson I, Jones-Dillon SA, et al. Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019 Apr;28(2):114-123. doi:10.1080/08037051.2019.1568183Wolf VL, Ryan MJ.Autoimmune disease-associated hypertension.Curr Hypertens Rep. 2019;21(1):10. doi:10.1007/s11906-019-0914-2Johnson W, Nguyen ML, Patel R.Hypertension crisis in the emergency department.Cardiol Clin. 2012 Nov;30(4):533-43. doi:10.1016/j.ccl.2012.07.011Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34Additional ReadingAmerican Heart Association.Health threats from high blood pressure.Updated October 31, 2016.American Heart Association.Hypertensive crisis: When you should call 911 for high blood pressure.Updated November 30, 2017.

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Salkic S, Batic-Mujanovic O, Ljuca F, et al.Clinical presentation of hypertensive crises in emergency medical services. Mater Sociomed. 2014;26(1):12-16. doi:10.5455/msm.2014.26.12-16Almas A, Ghouse A, Iftikhar AR, et al.Hypertensive crisis, burden, management, and outcome at a tertiary care center in Karachi.International Journal of Chronic Diseases.2014;1–7. doi:10.1155/2014/413071Breu AC, Axon RN.Acute treatment of hypertensive urgency. J Hosp Med. 2018 Dec 1;13(12):860-862. doi:10.12788/jhm.3086Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD.Advances in management of acute hypertension: A concise review.Discov Med. 2012;13(72):375-383.Waldron FA, Benenson I, Jones-Dillon SA, et al. Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019 Apr;28(2):114-123. doi:10.1080/08037051.2019.1568183Wolf VL, Ryan MJ.Autoimmune disease-associated hypertension.Curr Hypertens Rep. 2019;21(1):10. doi:10.1007/s11906-019-0914-2Johnson W, Nguyen ML, Patel R.Hypertension crisis in the emergency department.Cardiol Clin. 2012 Nov;30(4):533-43. doi:10.1016/j.ccl.2012.07.011Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34Additional ReadingAmerican Heart Association.Health threats from high blood pressure.Updated October 31, 2016.American Heart Association.Hypertensive crisis: When you should call 911 for high blood pressure.Updated November 30, 2017.

Salkic S, Batic-Mujanovic O, Ljuca F, et al.Clinical presentation of hypertensive crises in emergency medical services. Mater Sociomed. 2014;26(1):12-16. doi:10.5455/msm.2014.26.12-16Almas A, Ghouse A, Iftikhar AR, et al.Hypertensive crisis, burden, management, and outcome at a tertiary care center in Karachi.International Journal of Chronic Diseases.2014;1–7. doi:10.1155/2014/413071Breu AC, Axon RN.Acute treatment of hypertensive urgency. J Hosp Med. 2018 Dec 1;13(12):860-862. doi:10.12788/jhm.3086Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD.Advances in management of acute hypertension: A concise review.Discov Med. 2012;13(72):375-383.Waldron FA, Benenson I, Jones-Dillon SA, et al. Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019 Apr;28(2):114-123. doi:10.1080/08037051.2019.1568183Wolf VL, Ryan MJ.Autoimmune disease-associated hypertension.Curr Hypertens Rep. 2019;21(1):10. doi:10.1007/s11906-019-0914-2Johnson W, Nguyen ML, Patel R.Hypertension crisis in the emergency department.Cardiol Clin. 2012 Nov;30(4):533-43. doi:10.1016/j.ccl.2012.07.011Aronow WS.Treatment of hypertensive emergencies.Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34

Salkic S, Batic-Mujanovic O, Ljuca F, et al.Clinical presentation of hypertensive crises in emergency medical services. Mater Sociomed. 2014;26(1):12-16. doi:10.5455/msm.2014.26.12-16

Almas A, Ghouse A, Iftikhar AR, et al.Hypertensive crisis, burden, management, and outcome at a tertiary care center in Karachi.International Journal of Chronic Diseases.2014;1–7. doi:10.1155/2014/413071

Breu AC, Axon RN.Acute treatment of hypertensive urgency. J Hosp Med. 2018 Dec 1;13(12):860-862. doi:10.12788/jhm.3086

Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD.Advances in management of acute hypertension: A concise review.Discov Med. 2012;13(72):375-383.

Waldron FA, Benenson I, Jones-Dillon SA, et al. Prevalence and risk factors for hypertensive crisis in a predominantly African American inner-city community.Blood Press. 2019 Apr;28(2):114-123. doi:10.1080/08037051.2019.1568183

Wolf VL, Ryan MJ.Autoimmune disease-associated hypertension.Curr Hypertens Rep. 2019;21(1):10. doi:10.1007/s11906-019-0914-2

Johnson W, Nguyen ML, Patel R.Hypertension crisis in the emergency department.Cardiol Clin. 2012 Nov;30(4):533-43. doi:10.1016/j.ccl.2012.07.011

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

American Heart Association.Health threats from high blood pressure.Updated October 31, 2016.American Heart Association.Hypertensive crisis: When you should call 911 for high blood pressure.Updated November 30, 2017.

American Heart Association.Health threats from high blood pressure.Updated October 31, 2016.

American Heart Association.Hypertensive crisis: When you should call 911 for high blood pressure.Updated November 30, 2017.

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Hypertensive Crisis Types and Symptoms#

Hypertensive Urgency#

Hypertensive Emergency#

Complications#

A Word From Verywell#

Hypertensive Crisis Types and Symptoms

Hypertensive Urgency

Hypertensive Emergency

Complications

A Word From Verywell