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, during pregnancy, or in people with no known history of high blood pressure.
A blood pressure of 180/120 millimeters of mercury (mmHg) and higher 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 the emergency department.
High Blood Pressure: When to Go to Hospital
If you see a healthcare provider regularly, you may see blood pressure readings climbing steadily over time. If you fail to control your rising blood pressure, it can reach dangerous levels. This can also happen suddenly in certain situations, like during a stroke.
Emergency-level high blood pressure is considered either hypertensive urgency or a hypertensive emergency 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
- 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.
Treatment for Dangerous High Blood Pressure at Hospital
The first step in treating dangerously high blood pressure is to figure out 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 can include things like:
- Preeclampsia (high blood pressure in pregnancy)
- Aortic dissection (a tear in your aorta)
- Acute pulmonary edema (buildup of fluid in your lungs)
- Type 1 heart attack (heart attack caused by ruptured plaques)
- Stroke (an interruption in the blood supply to your brain)
- 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)
- Acute urinary retention (inability to pass urine)
If any 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.
Other problems that can contribute to severely high blood pressure but may not necessarily require direct blood pressure treatment include:
- Acute kidney injury (kidney damage or failure that occurs suddenly)
- Type 2 heart attack (a lack of blood flow or oxygen supply to the heart)
- Hypertensive encephalopathy (high blood pressure from mental status changes)
- Pulmonary edema (buildup of fluid in the lungs)
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.
If the source of your increase in blood pressure is uncertain, your healthcare team will likely perform additional diagnostic tests like a head computed tomography (CT) or electrocardiogram (EKG). 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.
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 blood pressures measuring 180s/120s and higher, the goal 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 mmHg or lower
- Elevated blood pressure: 120-129/80 mmHg or lower
- Hypertension stage 1: 130-139/80-89 mmHg
- Hypertension stage 2: 140-149/90 mmHg or higher
- Hypertensive crisis: 180/120 mmHg and higher
Uncontrolled blood pressure over time can lead to chronic and acute problems such as:
- Memory loss
- Loss of consciousness
- Vision damage
- Kidney damage
- Heart attack
- Aortic dissection
- Chest pain
- Pulmonary edema
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:
- Coronary artery disease
- Previous stroke
- High cholesterol
- Chronic kidney disease
- Congestive heart failure
- Substance abuse
If you have any of these conditions and notice your blood pressure is higher, 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 figure out 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.
If your blood pressure is routinely above 140 to 160 on the top number, you may have medications to take 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.
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 lightheadedness or chest pain, immediate treatment is necessary. If your blood pressure is high but you have no additional symptoms, your healthcare provider may want you hospitalized, 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 it rises close to 200 on the top number, This level of hypertension can increase your risk of stroke or other possibly fatal complications.