Hypertensive Crisis

What is a hypertensive crisis?

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.

Types of hypertensive crisis

• Hypertensive emergency: In addition to very high blood pressure, you have damage to your brain, heart, kidneys or blood vessels.
• Hypertensive urgency: You have very high blood pressure, but no signs of organ damage.

Who does a hypertensive crisis affect?

People who get a hypertensive crisis are more likely to:

• Be Black.
• Be male or assigned male at birth.
• Be older.
• Not take blood pressure medicines consistently.
• Have obesity.
• Have certain heart conditions.
• Be without a primary care provider.

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.

What are the symptoms?

Hypertensive crisis symptoms may include:

• Shortness of breath.
• Headache.
• Chest pain.
• Blurry vision.
• Heart palpitations.
• Anxiety.
• Dizziness.
• Nosebleed.
• Vomiting.

What causes hypertension crisis?

Hypertensive crisis causes include:

• Failure to take prescribed blood pressure medicines. This is the most common cause.
• Suddenly stopping the use of blood pressure medicines.
• Medications interacting with each other.
• Not receiving higher doses when current doses aren’t enough.
• Kidney disease.
• Endocrine issues.
• Preeclampsia or eclampsia during pregnancy.
• Use of recreational drugs.
• Head trauma.
• Brain tumor.

What drugs cause hypertensive crisis?

A number of medications can cause a hypertensive crisis, such as:

• Steroids.
• Medicines for depression.
• Cyclosporine.
• Pseudoephedrine.

What are the complications of a hypertension crisis?

Complications of a hypertensive crisis include:

• Pulmonary edema.
• Hypertensive encephalopathy (swelling in your brain).
• Heart failure.
• Heart attack.
• Aortic dissection.
• Stroke.
• Bleeding around your brain.

How is a hypertensive crisis diagnosed?

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.

What tests will be done to diagnose a hypertension crisis?

Tests to diagnose a hypertensive crisis and find a cause may include:

• Blood pressure check.
• Blood tests.
• Chest X-ray.
• Urine (pee) tests.
• Electrocardiogram (EKG).
• Computed tomography (CT) scan of your chest or head.
• Transthoracic echocardiogram (TTE).

How is a hypertensive crisis treated?

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:

• Aortic dissection.
• Acute pulmonary edema.
• Acute coronary syndrome.

You may need a hospital stay, depending on the type of hypertensive crisis you have.

• Hypertensive emergency: A provider will admit you to a hospital’s intensive care unit for treatment. In the hospital, a provider will monitor your blood pressure and give you IV medicines.
• Hypertensive urgency: A provider will give you medicine that you swallow to lower your blood pressure. You can go home from the emergency department, but you’ll need to follow up with a provider over the next few days.

What medications/treatments are used?

Medications for hypertensive crisis treatment include:

• Esmolol.
• Nitroglycerin.
• Nitroprusside.
• Labetalol.
• Hydralazine.

Complications/side effects of the treatment

Side effects of medications for a hypertensive crisis may include:

• Headache.
• Abnormal heart rhythms.
• Hypotension (low blood pressure).
• Heart palpitations.

How can I prevent a hypertensive crisis?

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:

• Keep taking medicines your provider prescribed for you — even if you feel fine.
• Check your blood pressure regularly at home.
• Contact your provider if your blood pressure is high.
• Eat a healthy diet low in salt.
• Exercise regularly.
• Avoid tobacco products.

What can I expect if I have a hypertensive crisis?

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.

How do I take care of myself?

To take care of yourself, you can:

• Follow your healthcare provider’s instructions for taking your blood pressure medicine.
• If you need help paying for medicines, get help so you don’t miss doses.
• If you need help remembering to take your pills, get a pill organizer and set alarms.
• If you’re having trouble with side effects from your medicine, ask your provider to prescribe a different medicine.

When should I see my healthcare provider?

Contact your provider right away if:

• You have a blood pressure of 180/120 or higher.
• It doesn’t get better after waiting five minutes and checking it again.
• You have symptoms of a hypertensive crisis.

When should I go to the ER?

Call your local emergency number if you have:

• A blood pressure of 180/120 or higher.
• Chest pain.
• Shortness of breath.
• Numbness.
• Vision changes.
• Trouble talking.

What questions should I ask my doctor?

Questions to ask your provider include:

• What type of hypertensive crisis do I have?
• Which medicine is the best treatment for me?
• How long will I need an increased dose of medicine?
• How soon should I follow up with you?

What is the difference between hypertension crisis and hypertension emergency?

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.