What’s the Difference Between a Hypertensive Crisis and High Blood Pressure?
A hypertensive crisis is different than simply having a high blood pressure reading.
High blood pressure is any blood pressure above 130/80 mmHg. When a person has consistently high blood pressure, they are usually diagnosed with high blood pressure (hypertension) and started on medication to treat it.
A hypertensive crisis means that a person’s high blood pressure falls into one of the following categories:
- Severe hypertension: This is when a person’s blood pressure is dangerously high (above 180/120 mmHg), but they have no signs of organ damage. This condition requires prompt treatment — usually within 1 week — to prevent it from progressing to a hypertensive emergency.
- Hypertensive emergency: This is when high blood pressure causes organ dysfunction. This high blood pressure level is determined by the degree of organ damage, not the actual number. However, blood pressure is often in the range of severe hypertension.
But don’t worry too much about the technical definitions. These terms help healthcare professionals diagnose and respond to different levels of hypertensive emergencies. The most important thing to know is that symptomatic high blood pressure requires immediate medical attention.
Some numbers are definitely too high to be safe, regardless of whether you have any symptoms. But even if your numbers don’t seem that high, it’s still a concern when high blood pressure causes new symptoms. Everyone is different, and people will start to experience symptoms from their high blood pressure at different rates. This is why both the actual numbers and how you feel are important.
So, how you measure your blood pressure is important. Not knowing how to measure your blood pressure can give you an inaccurate reading.
To make sure you get the most accurate reading possible:
- Use an automated, validated blood pressure monitor. These devices have been tested for accuracy.
- Rest for at least 5 minutes before taking your blood pressure.
- Remove any clothing from your upper arm before taking your blood pressure.
- Measure your blood pressure around your upper arm. The cuff should cover about 80% of the area from your elbow to your shoulder.
- When taking your blood pressure, sit quietly in a chair with your feet flat on the floor and your arms crossed over your chest.
A normal blood pressure is 120/80 mmHg. Any number higher than either of these is considered high. But your blood pressure is too high if it is above 180/120 mmHg.
If you feel fine despite your high blood pressure, you should still call and see your primary care doctor right away. They will usually adjust your medication quickly to try to lower your blood pressure. But if they can’t see you soon enough, they may ask you to go to the emergency room just to be safe.
It’s important to know that sometimes people with blood pressure readings lower than 180/120 mmHg should go to the emergency room as soon as possible for treatment. This is why the second question is so important.
What are the symptoms of a hypertensive crisis?
A hypertensive crisis becomes a true emergency if you’re experiencing any of the symptoms below:
- Severe headache: During a spike in blood pressure, the pressure builds up within the skull. This type of headache will usually feel more severe than typical, everyday headaches.
- Confusion: High pressure in the brain can also lead to a change in mental status. This can sometimes just look like mild confusion. So, if you or someone you know seems a little off, this might be a medical emergency.
- Stroke symptoms: Severe high blood pressure can lead to a stroke. Stroke symptoms include sudden weakness or numbness (often on one side of the body), sudden confusion, trouble seeing, slurred speech, or difficulty getting words out. Regardless of your blood pressure reading, you should call 911 for any of these symptoms.
- Change in consciousness: A hypertensive crisis can also change someone’s level of alertness, making them seem excessively sleepy. In severe cases, they may even pass out or have a seizure.
- Blurred vision: Even if you aren’t having a stroke, high blood pressure can still damage the blood vessels that supply the eyes. This can cause blurry vision.
- Chest pain: The chest pain in a hypertensive crisis is typically severe. It’s usually not related to chest movement or food intake.
- Trouble breathing: A hypertensive crisis can lead to heart failure, which can cause fluid to build up in the lungs. This can cause shortness of breath, particularly with exertion or lying flat.
- Nausea or vomiting: Nausea is sometimes the first sign of changing blood flow in the body. Even if you don’t have any pain, you should get checked out if you feel like you’re about to vomit.
- Severe anxiety: Having high blood pressure can trigger feelings of anxiety. Some people may have a fast heart rate or a sense of impending doom.
If you think you may be experiencing these symptoms, don’t wait to see if they go away or get worse. Head to the ER, where they can help you figure out if you’re having a hypertensive crisis.
High Blood Pressure Program created by Christian Goodman for all those people who want to lower blood pressure and get off their medications.
What can cause a hypertensive crisis?
Sometimes there’s no apparent cause for spikes in blood pressure. But the following can increase your risk of having a hypertensive crisis:
- Stopping your medications: People who suddenly stop blood pressure medications may have spikes in blood pressure. This can also happen with missed doses. These sudden spikes are especially common in people taking beta blockers or clonidine.
- Starting new medications: There are many medications that can potentially increase your blood pressure, like nonsteroidal anti-inflammatory (NSAID) medications and some cold and cough medications.
- Recreational drug use: Nicotine, methamphetamines, and cocaine are the most common drugs that lead to heart damage and hypertensive crisis.
- Pregnancy: Many people have blood pressure issues for the first time while pregnant. In pregnancy, the cutoff for a hypertensive emergency is lower (anything above 160/110 mmHg).
- Stress: The link between a hypertensive crisis and stress needs to be studied more. Still, studies have linked anxiety to hypertension, probably due to a brief increase in some hormones.
Even without any of the above circumstances or other medical problems, your blood pressure might increase over time. A hypertensive crisis can happen with the natural progression of hypertension.
How can you prevent a hypertensive crisis from happening?
You can lower your risk of a hypertensive crisis. These steps can help you avoid dangerously high blood pressure:
- Take your medications: Take your blood pressure medications as prescribed. To help you remember your medications, consider using strategies like pill counters or phone reminders.
- Don’t abruptly stop medications: If any of your blood pressure medications have side effects that you don’t like, talk with your healthcare team so you can try a different medication. This is safer than abruptly stopping a medication.
- Get guidance: Talk with your healthcare team and your pharmacist before starting new medications.
- Go for regular checkups: This way you’ll know if your blood pressure is slowly creeping up. A healthcare professional can help with lifestyle changes and medications to keep it in check.
- Try the DASH diet: DASH stands for “dietary approaches to stop hypertension.” Studies show this eating plan helps lower blood pressure.
If you’ve had a hypertensive emergency in the past, you’re not necessarily more likely to have one in the future. The critical thing is ongoing management of your blood pressure.
High Blood Pressure Program created by Christian Goodman for all those people who want to lower blood pressure and get off their medications.
