When Is Blood Pressure High Enough to Go to the Hospital?
Medically reviewed by Jeffrey S. Lander, MD
If your blood pressure spikes dangerously high, it is a medical emergency. A high spike in blood pressure may occur in people with known high blood pressure, in those who are pregnant, or in people with no known history of high blood pressure.
A blood pressure of 180/120 millimeters of mercury (mm Hg) and higher along with the presence of additional symptoms, such as chest or back pain, shortness of breath, vision, changes, or difficulty speaking, signals a hypertensive crisis that needs immediate emergency treatment at a hospital.
If you don't have additional symptoms, your healthcare provider is less likely to recommend treatment in a hospital but will take measures to control your blood pressure.
This article will explore how high is too high when it comes to blood pressure. You will learn what numbers will lead to a diagnosis of high blood pressure, and what blood pressure readings or symptoms should prompt a visit to a hospital emergency department.
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High Blood Pressure: When to Go to the Hospital
If you visit a healthcare provider regularly, you may notice blood pressure readings that have climbed steadily over time. If you fail to control it, your rising blood pressure can reach dangerous levels. This can also happen suddenly with certain health events, such as a stroke.
Emergency-level high blood pressure is considered either hypertensive urgency or a hypertensive emergency, as defined below, based on what symptoms you have and whether your blood pressure decreases with additional measurements:
Hypertensive urgency is a blood pressure of 180/120 and higher with no significant symptoms.
Hypertensive emergency is a blood pressure of 180/120 and higher with the presence of symptoms that could signal additional problems.
Symptoms that can cause concern alongside high blood pressure and lead to a diagnosis of hypertensive crisis include:
Chest pain
Shortness of breath
Back pain
Numbness or tingling in your hands or feet
Vision changes
Sweating
Speaking problems
Hypertensive urgency should prompt a call to your healthcare provider if you've already been diagnosed with high blood pressure. If you are already being treated for high blood pressure, hypertensive urgency may lead to a change or increase in your medications.
However, if you are having symptoms of a hypertensive crisis or your blood pressure spikes suddenly without a history of hypertension, do not wait to seek medical care. Call 911 immediately or head to your nearest emergency department.
Hospital Treatment for Dangerous High Blood Pressure
The first step in treating dangerously high blood pressure is to determine if it is an isolated event, part of a chronic blood pressure problem, or related to some other medical emergency.
Underlying conditions that can contribute to a hypertensive emergency include the following:
Preeclampsia (high blood pressure in pregnancy)
Stroke (an interruption in the blood supply to your brain) or head trauma
Scleroderma renal crisis (high blood pressure that leads to kidney damage in people with scleroderma)
Sympathomimetic intoxication (agitation due to intoxication)
Hyperthyroidism (overactive thyroid gland)
Other endocrine disorders
Missed doses of blood pressure medications
Uncontrolled high blood pressure
Pain
Acute urinary retention (inability to pass urine)
Kidney diseases
If one or more of these conditions are suspected, your healthcare team will not blindly or generically treat your blood pressure. Instead, the underlying cause will be addressed with a targeted treatment and the assumption that treating that cause will, in turn, treat your blood pressure.
For some of these conditions, you may be given medication to lower your blood pressure immediately or for a short time, but ongoing treatment will focus on resolving the underlying condition or problem. The amount of damage to organs like the heart, kidneys, lungs, and other organ systems will factor into how your blood pressure is treated going forward.
Issues caused by severely high blood pressure that require urgent treatment include:
Acute kidney injury (kidney damage or failure that occurs suddenly)
Hypertensive encephalopathy (high blood pressure from mental status changes)
Aortic dissection (a tear in your aorta)
Acute pulmonary edema (buildup of fluid in your lungs)
Heart attack
The source of your high blood pressure and how much damage it may have caused will be investigated with diagnostic tests like:
Ultrasound imaging of the kidneys or other blood vessels
Clear issues involving an overload of fluid, pain, agitation, or drug withdrawal may also be treated separately.
If your high blood pressure is not improving with treatment of an underlying cause, you will likely be given intravenous medications that can quickly reduce your blood pressure to prevent secondary problems.
Which antihypertensive (medication to lower blood pressure) your healthcare team chooses may depend on what they determine to be an underlying or contributing cause.
Time Matters
Treating excessively high blood pressure is a time-sensitive problem. Dangerously high blood pressure for even a short time can put you at risk of more problems, like a stroke.
If you have a blood pressure reading with a systolic (top) number in the 180s or higher and a diastolic (bottom) number in the 120s, your goal typically will be to identify and treat the underlying cause and/or your blood pressure quickly.
One study that compared the use of intravenous nicardipine to labetalol in treating hypertensive emergency found that nicardipine helped people achieve a target blood pressure within 30 minutes in more cases than labetalol. Your healthcare provider will use all of your personal health information and assessment data to choose the best possible medication for your situation.
Risks of Unmanaged High Blood Pressure
A hypertensive crisis is a medical emergency that must be treated quickly and effectively to avoid possibly fatal consequences.
Blood pressure can creep up slowly over time, though, and having high blood pressure that you don't manage well over long periods of time can take just as dangerous a toll on your body.
High blood pressure is commonly referred to as a "silent killer" since it can develop gradually over time with almost no symptoms until it creates a serious problem. Over time, high blood pressure—or hypertension—can contribute to a range of problems with your heart, brain, kidneys, and circulatory system.
You may receive a high blood pressure diagnosis in different categories.
Normal blood pressure: 120/80 mm Hg or lower
Elevated blood pressure: 120–129/80 mm Hg or lower
Hypertension stage 1: 130–139/80–89 mm Hg
Hypertension stage 2: 140–149/90 mm Hg or higher
Hypertensive crisis: 180/120 mm Hg and higher
Uncontrolled blood pressure over time can lead to chronic and acute problems such as:
Stroke
Memory loss
Loss of consciousness
Vision damage
Kidney damage
Heart attack
Aortic dissection
Chest pain
Pulmonary edema
Eclampsia
Special Considerations for Blood Pressure
Severely high blood pressure is dangerous for just about everyone, but people with specific medical issues may be at an even greater risk than others. Some conditions that can increase your risk of dangerous complications in a hypertensive emergency include:
Diabetes
Coronary artery disease
Previous stroke
High cholesterol
Chronic kidney disease
Congestive heart failure
Substance use disorder
If you have any of these conditions and notice your blood pressure is rising, seek immediate treatment or call your healthcare provider.
After a Hypertension Episode: Ongoing Management
Treating a hypertensive emergency doesn't stop with one medication. Your healthcare provider will need to determine why your blood pressure climbed so high and how to prevent it from happening again. If you are already being treated for high blood pressure, your healthcare provider may adjust some of your regular antihypertensive medications.
You'll also get information on when to call your healthcare provider in the future. If you are on daily blood pressure medication, you and your healthcare provider should have a clear plan of what to do if your numbers begin to climb.
Blood pressure that is routinely elevated requires standing medication. Blood pressure that is intermittently high may need medications on an as-needed basis. Generally, if you have a blood pressure reading higher than normal with no symptoms, your healthcare provider will want you to wait five minutes and then take another measurement.
Continued high blood pressure on repeated readings, high blood pressure that doesn't improve with your regular or as-needed medications, or hypertension that comes with other symptoms should prompt additional calls to your healthcare provider or a visit to the emergency department.
Rehospitalization With High Blood Pressure
The goal of treating a hypertensive emergency is immediate blood pressure reduction, but with hypertensive urgency, the goal is to lower your blood pressure in a day or two. Your healthcare provider may be hesitant to lower your blood pressure by more than 25% at a time, even when it's high.
Some conditions, like a stroke, may also be treated with something called permissive hypertension. In this scenario, your healthcare provider won't let your blood pressure get too low with treatment—instead, keeping it a bit above normal levels in order to ensure you get enough blood flow to your brain and other tissues.
If your healthcare team is struggling to get your blood pressure under control on a regular basis, your medications may be adjusted on an outpatient visit, or you could be readmitted to the hospital for further testing, observation, and medical management.
Summary
A blood pressure with a top number in the 140s to 160s is dangerous as a rule, but blood pressures that spike into the 180s or 200s are considered an emergency. If you are having symptoms like light-headedness or chest pain, immediate treatment is necessary. If your blood pressure is high but you have no additional symptoms, your healthcare provider may want to admit you to the hospital, but your blood pressure will be treated less urgently.
Getting good control over your blood pressure is important as a maintenance measure, but it's critical that you call your healthcare provider or seek care right away if the top number rises close to 200, This level of hypertension can increase your risk of stroke or other possibly fatal complications.
Read the original article on Verywell Health.
