Hypertensive crisis is very high blood pressure that happens without warning. Your reading can be 180/120 millimeters of mercury or higher. If this happens, take it seriously and call for help immediately. Without treatment for this dangerous condition, you can have life-limiting issues with your heart, lung or brain.
A hypertensive crisis means you suddenly have severely high blood pressure (180/120 millimeters of mercury or higher). A normal blood pressure reading is 120/80 millimeters of mercury.
You need to get help for very high blood pressure right away. Without treatment, you can have serious issues that can be life-threatening.
People who get a hypertensive crisis are more likely to:
How common is hypertension crisis?
About 1% to 2% of people who have high blood pressure have a hypertensive crisis. Before blood pressure medicines were so common, about 7% of people with high blood pressure had a hypertensive crisis at some point.
Most people (75%) who seek emergency care for a hypertensive crisis have hypertensive urgency. The other 25% have hypertensive emergency. This smaller group makes up .2% of adult visits to emergency departments in the U.S.
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Hypertensive crisis symptoms may include:
Hypertensive crisis causes include:
A number of medications can cause a hypertensive crisis, such as:
Complications of a hypertensive crisis include:
A healthcare provider will take your blood pressure in both arms to diagnose a hypertensive crisis. A physical exam and other tests can help find the cause.
They’ll diagnose you with a hypertensive emergency if you have signs of damage to your kidneys, heart, brain or eyes. This can include conditions like heart failure or loss of vision.
Tests to diagnose a hypertensive crisis and find a cause may include:
The goal of hypertensive crisis treatment is to bring your blood pressure down to a safe level. However, a provider will lower your blood pressure more quickly or slowly depending on what other medical condition you have. They may lower it immediately or by 15% to 25% over an hour or two.
For example, if you have an intracranial hemorrhage (brain bleed) or ischemic stroke, a provider will lower your blood pressure by only 15% during the first hour. For a person with hypertensive encephalopathy, a provider will lower blood pressure by 20% to 25% during the first few hours.
Then, they’ll reduce it more over several hours or days.
A provider will bring your blood pressure down gradually to make sure your organs get enough blood supply. Bringing your blood pressure down too quickly when you don’t have organ damage can send too little blood to your organs.
However, a provider will bring your blood pressure down quickly if you have:
You may need a hospital stay, depending on the type of hypertensive crisis you have.
Medications for hypertensive crisis treatment include:
Side effects of medications for a hypertensive crisis may include:
If you have high blood pressure, the best way to prevent a hypertensive crisis is to manage your blood pressure every day. Here’s how you can do it:
Depending on the type of hypertensive crisis you have, you may need to be in the hospital for a day or more. Or you may go home after treatment.
One study found that people who sought emergency treatment for hypertensive urgency had a 50% higher risk of a cardiovascular (heart or blood vessel) issue than those with high blood pressure below crisis level.
Another study found that 2.6% of people admitted to U.S. hospitals for a hypertensive crisis didn’t survive.
To take care of yourself, you can:
Contact your provider right away if:
Call your local emergency number if you have:
Questions to ask your provider include:
A hypertension emergency is a type of hypertension crisis. In addition to very high blood pressure, you have damage to some of your organs.
A note from Cleveland Clinic
Having very high blood pressure can put you at risk for serious health issues. You can help yourself by knowing the symptoms to watch for and what to do. As many cases of hypertensive crisis happen because of people not taking their blood pressure medicine, the best thing you can do is stick to your healthcare provider’s plan for you. Don’t be afraid to ask questions or ask for help if you’re having a hard time getting your medicines or remembering to take them.
Last reviewed by a Cleveland Clinic medical professional on 11/22/2022.
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