Hypertensive Crisis

What is hypertensive crisis?

Hypertensive crisis occurs when your blood pressure becomes dangerously high (180/120 mm Hg), to a level that can damage your organs. Hypertensive crisis is categorized as "hypertensive urgency" if the blood pressure is high without damage to organs, and as "hypertensive emergency" if the blood pressure is high with damage to organs.

Symptoms for hypertensive urgency are usually not noticeable, except for high blood pressure and a mild headache. However, hypertensive emergency symptoms also include a possibly severe headache, confusion, agitation or seizures, numbness or weakness, blurry vision, nausea or vomiting, chest pain, and back pain.

Treatments include methods to reduce stress and lower blood pressure, by either IV or oral medication.

A hypertensive crisis is an emergency requiring immediate attention. Call 911.

Hypertensive crisis symptoms

People with hypertensive urgency usually have no symptoms other than high blood pressure or possibly a mild headache. However, people with hypertensive emergency will have one or more of the following symptoms in addition to high blood pressure that can be categorized as those that affect the head and neurologic functioning, the chest, and the stomach and urinary system.

Head and neurologic symptoms

Symptoms that will be experienced in the head or related to neurologic function include:

• Headache: A mild or severe headache can be due to increased pressure in the head or a bleed in the brain.
• Confusion, agitation, or seizures: Increased pressure in the head, a bleed in the brain, or decreased blood flow to a part of the brain causing a stroke can cause confusion, seizures, agitation or other changes in behavior.
• Numbness or weakness: Sudden numbness or weakness in a part of the body is usually due to decreased blood flow to a part of the brain causing a stroke.
• Blurry vision: High blood pressure can cause blurry vision by increasing the pressure on the nerves that provide vision, or by causing bleeding in the back of the eye.

Chest-related symptoms

Certain chest-related symptoms that may be very severe can occur, such as:

• Chest pain or discomfort: Decreased blood flow to the heart, if prolonged, can cause a heart attack. This can also be due to damage to the aorta (the large blood vessel leaving the heart to supply the rest of the body).
• Back pain: Sudden severe back pain can occur if high blood pressure damages the aorta.
• Shortness of breath: Whether coming on suddenly or gradually, shortness of breath can occur if the high blood pressure decreases blood flow to the heart, preventing it from functioning properly and causing fluid to back up into the lungs. This can also occur if the high blood pressure damages the kidneys, preventing them from producing urine, which can cause fluid to accumulate throughout the body.

Stomach and urinary symptoms

These symptoms occur due to high blood pressure eliciting a full-body response or indicating signs of kidney damage.

• Nausea or vomiting: Hypertensive crisis can cause people to feel nauseous or throw up by increasing the pressure in the head.
• Red-colored urine: Development of red-colored urine can occur if the high blood pressure damages the kidneys, causing blood to appear in the urine (hematuria).

Hypertensive crisis causes

Causes of hypertensive crisis include those related to your lifestyle, genetics or having certain diseases, as well as unplanned complications or injuries.

Lifestyle and preventable causes

Certain causes of high blood pressure are preventable or can be alleviated with changes to your lifestyle. This includes:

• Not taking blood pressure medications as instructed: This can lead to a sudden increase in blood pressure to dangerous levels. This "rebound" effect is particularly common with medications that can cause a sudden increase in blood pressure if stopped suddenly, such as clonidine and propranolol.
• Eating more salt than recommended: Eating too much salt causes the body to hold onto more water, which increases blood pressure.
• Taking certain medications or drugs: Certain medications or drugs can raise blood pressure, such as oral contraceptive pills, over-the-counter painkillers, and steroids, as well as cocaine or methamphetamines.

Genetics and diseases

Certain inherited or acquired issues leading to high blood pressure include:

• Having kidney disease: The kidneys are responsible for filtering blood, producing urine, and maintaining normal blood pressure, so if the kidneys are not functioning properly, blood pressure can increase.
• Having a disease involving imbalanced hormones: Imbalanced hormones due to disease, including aldosterone, cortisol, thyroid hormone, parathyroid hormone, or catecholamines can cause high blood pressure.

Complications or injury

Certain causes of hypertensive crises cannot be prevented or predicted. This includes:

• Developing a complication during pregnancy: Pregnant women may develop a complication known as preeclampsia, which involves very high blood pressures that can damage other organs in the body.
• Sustaining a head Injury: A head injury can increase the pressure inside the head, which can cause a hypertensive crisis.

Treatment options and prevention for hypertensive crisis

For people experiencing a hypertensive crisis, the immediate goal of treatment is to gradually reduce the blood pressure to a safe level (but not in an immediate manner as this can be dangerous to do). Your target blood pressure and how quickly your blood pressure should be lowered will vary depending on your specific situation and the cause of the hypertensive crisis.

Specific treatment options below will likely occur sequentially or depending on the severity of your symptoms.

• Sitting in a quiet room to rest: If you are having a hypertensive crisis without other symptoms or damage to other organs (hypertensive urgency), your physician may recommend that you first try sitting in a quiet room to rest. This alone has been shown to reduce blood pressure in some adults.
• Medications given through an IV to lower blood pressure: Hypertensive crises are a medical emergency. Some medications are given through an IV to lower your blood pressure more quickly.
• Medications given as oral pills to lower blood pressure: If you are having a hypertensive crisis without other symptoms or damage to other organs (hypertensive urgency), or if your blood pressure has already been lowered with medications given through an IV, your physician may recommend one or more medications given as oral pills to lower your blood pressure more slowly. Potassium supplements can help balance the effects of sodium and is important for maintaining healthy blood pressure levels. Always check with your doctor before starting any supplement.

When to seek further consultation for hypertensive crisis

You should seek medical attention if you believe you are experiencing a hypertensive crisis or your blood pressure is dangerously high.

If you experience any symptoms of hypertensive crisis

You should see your physician right away if you experience a severe headache, confusion or agitation, seizures, numbness or weakness, blurry vision, nausea or vomiting, chest pain, back pain, shortness of breath, or red-colored urine. If the symptoms are severe, you should consider going to the emergency room or calling an ambulance. In a hypertensive crisis, it is important to lower the blood pressure to a safe level in a reasonable amount of time to prevent damage to any organs.

If you measure your blood pressure at home and it is 180/120 mm Hg

You should see your physician right away, even if you don't feel any symptoms. He or she can recommend treatments to bring your blood pressure down to a safe level.