Hypertensive crisis: when is it an emergency and what to do?

Seeing a very high figure on the baumanometer can be frightening. And rightly so: some situations require immediate attention. But not every elevated pressure is an emergency. The key is to distinguish between “very high blood pressure” and “high blood pressure with damage or alarm symptoms,” and to know what to do at that moment without making things worse.

The most important

• It is considered emergency when the pressure is very high and there is also warning signs or suspected organ damage (brain, heart, kidney, eyes).
• If the pressure is high but you feel stable and without alarm symptoms, is usually a hypertensive urgencyrequires prompt medical assessment and adjustment, but does not always require an ambulance.
• Do not self-medicate with “extra doses” without indication. Lowering your blood pressure too quickly can be risky.

First: what is a hypertensive crisis?

In practical terms, a “hypertensive crisis” is used when the pressure is very high, commonly with figures in the range of 180/120 mmHg or more. From there, the important thing is the context:

• Hypertensive emergency: very high pressure + alarm symptoms or organ damage data.
• Hypertensive emergency: very high pressure without immediate alarm symptoms, but requires adjustment and close monitoring.

How to confirm the number (before panicking)

An isolated reading can go wrong due to technique, stress or pain. Do this:

1. Sit for 5 minutes, back flat, feet on the floor.
2. Do not talk during the measurement.
3. Secure bracelet of the correct size and arm at heart level.
4. Repeat 2 times (1 minute apart) and record the average.

If you would like to review goals and technique, check out blood pressure: goals and measurement at home and the article by hypertension.

When is it a real emergency (warning signs)?

Seek immediate attention (emergency room/ambulance) if very high blood pressure is accompanied by any of these symptoms:

• Chest pain or pressure, or significant shortness of breath (may be related to cardiac events). Lean on acute myocardial infarction and in chest pain: common causes and when is it an emergency?.
• Weakness on one side of the body, slurred speech, facial deviation or sudden loss of vision (suspected cerebral event).
• Headache very intense and different from the usual, with confusion, marked drowsiness or convulsions.
• Fainting or a feeling that “you are going to faint” with general malaise.
• Shortness of breath at rest, purple lips, or rapid worsening.

If someone loses consciousness or stops breathing normally, check the guide for cardiopulmonary resuscitation (CPR).

What to do at the moment?

If there are warning signs

• Call 911 or go to the emergency room immediately.
• Do not drive if you feel unwell or if chest pain or shortness of breath is significant.
• Keep (if you have it) a list of medications, dosage and time of the last intake.

If there are NO warning signs, but the number is too high

1. Repeat the measurement correctly (as above).
2. Avoid exercise, coffee, alcohol and tobacco at this time.
3. If you are already taking treatment for blood pressure, check if there was a clear cause: missed dose, sleeplessness, pain, stress, excess salt, anti-inflammatory drugs, decongestants, etc.
4. Contact your physician for indications or schedule an early assessment, especially if the number remains very high.

What NOT to do (common mistakes)

• Do not take “double doses” or borrow medications to lower your blood pressure all at once.
• Do not use home remedies to “go down fast”.
• Don't stay at home if there are warning signs, even if “I'm already down a little”.

Frequent causes of pressure spikes

• Forgetting treatment or discontinuation “because I felt well”.
• Acute stress, sleeplessness, severe pain or anxiety. You can complement with stress, sleep and heart health.
• Excess salt, alcohol or highly processed food.
• Medications that raise blood pressure (e.g., some anti-inflammatory or decongestants).
• Poorly controlled baseline pressure, without follow-up.

What the medical evaluation may include

Depending on symptoms and history, the evaluation seeks to rule out organ damage and adjust treatment. It may include:

• Clinical review and complete examination
• Electrocardiogram for chest pain, palpitations or shortness of breath
• Blood/urine studies and renal function evaluation on a case-by-case basis
• Adjustment of treatment and follow-up plan

If your control is irregular, it is often useful to define goals and monitoring. Check MAP 24 hours as a tool when you need to understand how your pressure behaves during the day and night.

When to schedule a consultation (even though the scare is over)

Agenda valuation yes:

• You had a very high figure even though it dropped later on.
• You have repeated high readings during the week.
• You are taking treatment and it still remains high
• Diabetes, renal disease, high cholesterol or history of heart attack/CVS (higher risk)

You can learn about the cardiological check up o schedule an appointment.

References

• American Heart Association. Hypertensive Crisis: When You Should Call 911 for High Blood Pressure. See source
• Mayo Clinic. High blood pressure (hypertension): Symptoms and causes. See source
• NHS. High blood pressure (hypertension). See source
• ACC/AHA. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.. See source