What Is a Hypertensive Crisis in High Blood Pressure?

You’re having a hypertensive crisis if your blood pressure suddenly rises above 180/110-120. This can be life-threatening.

“Hypertensive crises are extremely serious medical emergencies that can lead to irreversible end-organ damage,” says nephrologist Omar Al Dhaybi, MD, director of the Hypertension Center at Mount Sinai Fuster Heart Hospital in New York City.

There are two types of hypertensive crisis: severe hypertension and hypertensive emergency.

Severe hypertension (hypertensive urgency)

If you are having this type of hypertensive crisis, your blood pressure will be higher than 180/110-120, but you won’t have any signs of organ damage and few, if any, symptoms. Severe hypertension used to be called “hypertensive urgency.”

“The previous term is considered emotionally charged and potentially misleading,” Dhaybi says. 

It often led to unnecessary and aggressive treatment. Such treatment can put you at risk of low blood pressure (hypotension) as well as unpredictable changes in blood pressure, a condition called labile hypertension.

Hypertensive emergency

A hypertensive emergency is a much more dangerous type of hypertensive crisis. It can cause potentially fatal organ damage. The organs most likely to be affected include your:

• Heart, which can lead to acute heart failure, heart attack, or aortic dissection (a tear in your body’s largest artery, the aorta, which is attached to your heart)
• Kidneys, possibly leading to acute kidney failure or oliguria (not peeing enough)
• Brain, which can lead to hemorrhagic or ischemic stroke, brain dysfunction (hypertensive encephalopathy), and bleeding around your brain (intracranial hemorrhage)
• Lungs, which may lead to a sudden buildup of fluid called pulmonary edema
• Eyes, which can lead to swelling of the optic nerve (papilledema), which in turn can cause vision problems, including partial or complete blindness

A hypertensive emergency often happens when high blood pressure goes untreated. For example, it can happen if you don’t take your blood pressure medication or if you’ve taken an over-the-counter medication that makes high blood pressure worse.

A hypertensive crisis happens without any specific cause, says Jim Liu, MD, a cardiologist at the Ohio State University Wexner Medical Center in Columbus, Ohio. But the most common cause is not taking your prescribed blood pressure medication. Other causes include:

• Not sticking to a low-sodium diet as part of your high blood pressure management plan
• Kidney disease
• Endocrine disorders
• Preeclampsia, which can happen during pregnancy
• Panic attacks
• Migraine
• Thyroid disease
• Pheochromocytoma, a rare type of tumor that grows in the adrenal glands
• Use of drugs and addictive substances
• Certain medications, such as steroids, some antidepressants, cold and flu drugs that have pseudoephedrine, and cyclosporine (taken after an organ transplant)

Symptoms of a hypertensive crisis may include:

• Headache or blurred vision
• Increasing confusion
• Seizure
• Increasing chest pain
• Increasing shortness of breath
• Swelling or edema (fluid buildup in the tissues)

If you suspect that you or someone you are with is having a hypertensive crisis, call 911 immediately. This is a medical emergency and can be fatal if not treated right away.

To diagnose a hypertensive crisis, your health care providers will ask you several questions to get a better understanding of your medical history. For example, they may ask whether you’re taking blood pressure medication or if you’ve recently eaten something salty. They’ll also need to know all the medications you take, including nonprescription and recreational drugs. Be sure to tell them if you are taking any herbal or dietary supplements as well.

To check your blood pressure and look for signs of organ damage, you may get certain tests, including:

• Regular monitoring of blood pressure
• An eye exam to look for swelling and bleeding
• Blood and urine tests

A true hypertensive emergency needs immediate medical attention. The first step of treatment will likely include a trip to an intensive care unit (ICU). Chances are that you’ll stay in the ICU there for at least two days, Dhaybi says.

Once you’ve been admitted, the medical team will work to lower your blood pressure. This takes time. The goal during the first hour is to lower your systolic blood pressure (the top number in your blood pressure reading) by no more than 25% and to get your diastolic blood pressure (the bottom number in your blood pressure reading) below 120, says Dhaybi.

Then, your medical team will slowly lower your blood pressure to about 160/100. They’ll do this over the course of 6-12 hours. Finally, your systolic blood pressure will be brought down to 130-140 over the next 12-24 hours.

This gradual approach helps protect you against the risk of organ damage. That’s because lowering blood pressure too quickly can cut off adequate blood flow to your organs. But some medical conditions need a rapid decline in blood pressure.

“These include acute aortic dissection, severe preeclampsia or eclampsia in pregnancy, and pheochromocytoma crisis, all of which pose an imminent threat to life if not addressed immediately,” Dhaybi says.

Usually, intracranial hemorrhage (bleeding around the brain) also requires a quick lowering of your blood pressure, Liu says.

There are many medicines used to lower blood pressure during a hypertensive emergency. You’ll get these medications directly into your vein (intravenously, or IV). These drugs include:

The best thing you can do for yourself is to avoid a hypertensive crisis — and particularly a hypertensive emergency — in the first place.

“A single episode of hypertensive emergency significantly increases the likelihood of future episodes,” Dhaybi says.

Since the most common cause of a hypertensive crisis is not taking your high blood pressure medication, you can cut your risk by taking your medication as prescribed. Also, it’s important to make healthy lifestyle changes, including:

• Eating a nutritious, low-sodium diet
• Maintaining a healthy weight
• Exercising regularly
• Quitting smoking
• Quitting or cutting back on alcohol

Your doctor can help you develop a plan to put such lifestyle changes into practice. You should see your doctor regularly to make sure your blood pressure stays controlled. Your doctor will examine you to determine what’s causing your high blood pressure, such as hormonal disorders.

Be sure to learn about the symptoms of a hypertensive emergency so you can recognize what’s happening and reach the hospital right away.

A hypertensive crisis — in which your blood pressure suddenly and dangerously rises — can be a life-threatening medical emergency. It requires immediate treatment in an intensive care unit to prevent or stop damage to your heart, kidneys, brain, and other organs. Call 911 if you think you or someone you’re with is having a hypertensive crisis.

Here are some frequently asked questions about hypertensive crisis. 

Can anxiety cause a hypertensive crisis?

Yes, anxiety can trigger a hypertensive crisis. It can also be a symptom of high blood pressure.

Can a hypertensive crisis cause seizures?

Yes. A hypertensive crisis can lead to hypertensive encephalopathy, which can cause seizures in severe cases.

Can high blood pressure of 180/110 be life-threatening?

Yes. A blood pressure reading of 180/110 is considered a hypertensive emergency when you also have organ damage, and this can be fatal.