How To Know If High Blood Pressure Is An Emergency

If you live with high blood pressure, it can be difficult to know when it becomes an emergency as the symptoms and signs are not always obvious.  However, if left unchecked, it can gradually damage your blood vessels, heart, kidney, and other vital body organs.  Sudden changes in blood pressure can also cause harm.

Blood pressure is the force of blood pushing against the walls of your arteries as the heart pumps blood. It is measured by using a blood pressure cuff which is placed around your arm, gradually tightens, and then releases.  The results are given in two numbers. A blood pressure reading is given as the systolic blood pressure number (first number) over the diastolic blood pressure number (second number). Blood pressure levels are classified based on those two numbers.

In this piece, we share insights into managing high blood pressure, how to know when high blood pressure is an emergency and what to do in case of a high blood pressure emergency.

High blood pressure diagnosis

Hypertension is often called a "silent killer".  Approximately a third of people¹ with hypertension don't know they have this condition because it may have no warning signs or symptoms. When symptoms do occur, these may include early morning headaches, nosebleeds, irregular heartbeat, and changes to vision or the inner ear. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

The best way to know whether you have hypertension is through regular health check-ups. The doctor will refer to your medical history and conduct a physical examination to rule out or detect hypertension. You can also purchase a blood pressure machine to monitor your pressure at home if you are hypertensive or have a family member with high blood pressure.

Blood pressure measurements fall into different categories. For ordinary healthy adults, the pressure should be less than 120/80mmHg. If your readings are higher or lower than the healthy limits, the diagnosis can be as follows:

Elevated high blood pressure: Any value that ranges between 120/80 and 130/80mm Hg.

Stage 1 hypertension: 130/80 to 140/90mm Hg

Stage 2 hypertension: 140/90mm Hg and above

Hypertensive emergency: 180/120mm Hg and above.  If you record these values, you should go to the ER immediately as this is life-threatening.

The good news is that you can effectively manage stage I and II hypertension through diet, medication, and lifestyle changes. Doctors usually recommend a combined therapy when treating the stages of hypertension and regular three-monthly blood pressure measurement.

In 2020, the American Heart Association recommended² that your doctor adds blood pressure medication if diet, medication, and lifestyle changes have not lowered blood pressure to below 130/80mm Hg, especially if you have a family history of hypertension or other risk factors.

When is high blood pressure an emergency (hypertensive crisis)?

Doctors consider high blood pressure an emergency when pressure readings exceed 180/120mm Hg.  In this state, you may experience fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

It’s also very possible you’ll experience chest pain, confusion, and possibly stroke. However, this situation is quite rare and often occurs because a patient fails to take their medication, as recommended by their doctor.

Common causes of extremely high blood pressure

Lifestyle choices

Being overweight, consuming a high-fat diet, smoking excessively and drinking alcohol, and specific medication can also raise the risk of hypertension.

Genetics

One major cause of hypertension is genetic predisposition. The probability of developing hypertension is higher in adults with a family history of high blood pressure or diabetes, for those with kidney disease, lupus, hyper or hypothyroidism, and obstructive sleep apnea.

Special situations

High blood pressure may occur in pregnancy.  There are special considerations for children with high blood pressure.

Is high blood pressure an emergency during pregnancy?

If you are expectant, a blood pressure reading above 140/90mm Hg is considered an emergency, and you should talk to a physician immediately. Below are some high blood pressure symptoms you should watch out for when pregnant:

• Headache

• Vision changes

• Upper abdominal pain

• Swelling in the hands and feet

High blood pressure during pregnancy can be a result of the following causes:

• Diabetes

• Obesity

• Kidney disease

• Carrying more than one child

• Lupus

• Assisted pregnancy such as in vitro fertilization (IVF)

• First-time pregnancy

• Teen pregnancy or pregnant women over 40 years of age

• Recreational drug use e.g. cocaine, stimulants

If high blood pressure occurs in pregnancy after 20 weeks³, it can lead to severe damage to the mother’s organs, including the brain, and cause life-threatening seizures. The symptoms of these complications include protein in urine samples, vision changes, headache, swelling of feet and hands, and abdominal pain.

Other complications of high blood pressure during pregnancy include early placenta detachment and premature birth.

High blood pressure medical emergencies for children

Children have a different normal blood pressure range⁴ than adults. For children, normal blood pressure depends on their age, weight, and height. However, a blood pressure reading of 180/120mm Hg in children is also a medical emergency.

Factors like obesity, inactivity, and poor nutrition cause high blood pressure in children. Implementing lifestyle changes like enhanced physical activity and a diet low in sodium can help prevent blood pressure issues.

Diagnosing hypertension emergencies in children

The oscillometer is a device that is ideal for recording blood pressure readings after short intervals. Most doctors use this device to diagnose high blood pressure in children.

The doctor can also conduct intra-arterial blood pressure monitoring for more accurate results. They will also assess the medical history by asking vital questions such as:

• Whether the child is taking any drugs

• The existing symptoms

• Whether the child has any underlying medical conditions

In addition, they'll do a comprehensive physical examination, including blood and urine tests for a conclusive diagnosis. These tests are mainly to evaluate the possibility of organ damage.

Some advanced tests your doctor may perform on your child to detect organ damage include:

• Chest x-ray

• Magnetic resonance imaging (MRI)

• Electrocardiography 

• Computed tomography (CT)

Treating hypertensive emergencies in children

A child with a hypertensive emergency requires intensive care and the emergency department will handle the case for closer blood pressure monitoring and evaluation. What’s more, the child will receive intravenous antihypertensive drugs such as labetalol and nicardipine to stabilize their blood pressure.

The goal of these medications is to lower blood pressure and avoid life-threatening complications, including organ damage. A medical specialist with experience managing severe blood pressure in children should handle the case if possible. Once blood pressure stabilizes, the doctor can administer the drugs orally. If the condition doesn't cause organ damage, the child will only need hypertensive medication administered by mouth.

What is a hypertensive crisis?

When your blood pressure suddenly and severely surges, you experience a hypertensive crisis. However, this situation is quite rare and while some people will experience severe symptoms, others will not.

A hypertensive crisis occurs when the blood pressure reading goes up to 180/120mm Hg or more. Usually, you may experience symptoms such as shortness of breath, chest pain, change in vision, back pain, numbness, and difficulty speaking.

You may also experience fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.  It may cause chest pain, confusion, and possibly stroke. This case requires immediate medical assistance, so call 911 if you experience such symptoms.

On the other hand, a hypertensive urgency occurs when you record blood pressure readings of 180/120mm Hg or higher but doesn't cause severe organ damage. This situation is less severe, as you can bring your blood pressure down within a short time by taking the right medication. 

Treatment for hypertensive crisis

Most doctors will opt for an intravenous (injectable) medication to treat a hypertensive crisis, as this enters the bloodstream directly for faster results. The reduction in blood pressure should be gradual to limit other complications of fatigue, heart rhythm problems, fainting, and respiratory distress.

The goal is to lower blood pressure by about 25%⁵ within the first one to two hours. Once you gain stability, the doctor then administers oral antihypertensive medications.

The drugs prescribed differs depending on several factors such:

• If you're pregnant

• Whether you have an underlying medical condition

• Whether the hypertensive crisis is due to drug abuse

Complications of a hypertensive crisis

If you fail to treat extremely high blood pressure for a while, the risk of severe consequences like heart attack and stroke increases. A hypersensitive crisis can also lead to memory loss, damage to your eyes, kidney damage, or unconsciousness. Moreover, the main artery coming from your heart may tear and lead to fluid deposition into your lungs.

What can you do if you suspect you are experiencing a hypertensive crisis?

Follow these steps if you suspect you or someone close to you is experiencing a hypertensive crisis:

1. Check your blood pressure.

2. If the blood pressure is not over 180/120mm Hg and you're not showing any signs of severe high blood pressure, wait for five minutes and recheck your blood pressure. This time ensure you are fully relaxed and not hasty to avoid false elevated blood pressure readings. 

3. If the blood pressure remains unchanged or higher than the first reading, you need to seek medical attention immediately. Call your doctor immediately for advice, as you prepare to go to the emergency room. If you cannot call your doctor, ask your family member or friend to contact them. 

4. When your blood pressure is more than 180/120mm Hg, you are experiencing symptoms of hypertensive emergency such as upper back pain, severe headache, numbness or weakness, shortness of breath, difficulty in speaking, and loss of vision is an emergency. Immediately call your healthcare provider as you head to the emergency room for evaluation. 

When is blood pressure high enough to go to the hospital?

Seek immediate medical help if you record blood pressure readings over 180/120mm Hg. Besides the high-pressure readings, you also must see the doctor if you experience severe headaches, blurry vision, and nose bleeding. Call your doctor if you usually have a normal blood pressure range, but it begins to go above this range occasionally.

How to manage high blood pressure at home

The best way to manage high blood pressure at home is to adjust your lifestyle. Here are some recommendations:

Regular physical exercise

People with hypertension are advised to engage in moderate-intensity exercise for at least 150 minutes every week⁶ or 75 minutes of high-intensity exercise weekly. Some suitable activities include cycling, jogging, walking, aerobics, and swimming. Strength training is also recommended at least twice a week.

Diet

People with high blood pressure should implement a healthy heart diet:

• Reduce salt intake: Increased sodium intake contributes to extremely high blood pressure. Salt is the primary source of sodium in our diets. People with hypertension are advised to consume less than 2,300mg⁷ of sodium daily, approximately one teaspoon. 

• Avoid alcohol consumption: Alcohol consumption can increase your blood pressure. It contains calories that can contribute to unwanted weight gain, a risk factor for blood pressure. In addition, alcohol can interact with certain blood pressure medications, increasing their side effects. 

• Eat more fruits and vegetables: If you have high blood pressure, you need to reduce your intake of saturated fats in favor of unsaturated fats. Health practitioners recommend that you eat healthier foods such as whole grains, high fiber foods, a variety of fruits and vegetables, fish rich in omega-3, nuts, pulses, skinless poultry, and low-fat dairy. 

• Manage body weight: Excess weight causes the heart to work harder to pump blood around the body, leading to high blood pressure levels. For this reason, it is essential to manage your weight through a healthy diet with a calorie intake that matches your size, activity level, and sex.

Stress reduction

Learn to manage or avoid stress, so that it doesn’t impact your blood pressure. A great way to do this would be to adopt a few relaxation skills such as meditation, yoga, warm baths, or taking long walks. You should avoid consuming alcohol, smoking, and taking recreational drugs to cope with stress, which can contribute to elevated blood pressure.

Medication

Doctors often recommend specific medication to manage high blood pressure levels. The type of medication you will take depends on the individual and your underlying medical conditions. Ensure you carefully read the labels and only use medication prescribed by a medical practitioner.

The lowdown

If you have high blood pressure, you may or may not experience symptoms. So, if you are hypertensive, it's essential to monitor your blood pressure and take your medication per your doctor's recommendation.

Recording your blood pressure readings offers valuable information to your medical team if you experience a hypertensive emergency.  Moreover, you need to know the signs of hypertensive emergency and seek medical attention immediately.  If this occurs, ask your family member to drive you to the hospital.

Doctors do not recommend self-medication for high blood pressure of any kind. Get tested by a qualified professional, and they will prescribe the right form of medication for your condition. Remember to maintain the right diet, get enough sleep, stay physically active, cut down on alcohol and quit smoking.