Hypertensive Crisis – You’re CALLING 911 Or A Doctor!

hypertensive crisis

Hypertensive crisis is the most serious of the 5 blood pressure categories. Fortunately, I’ve never had blood pressure numbers this high and I hope you don’t either. If your blood pressure ever reaches hypertensive crisis, you’re going to do 1 of 2 things, either call a doctor or 911 (resource). But how do you know which one? It depends on your symptoms and knowing which phone call to make is crucial to your health.

What is hypertensive crisis? Hypertensive crisis is when your blood pressure rises quickly and severely. For your blood pressure to be in hypertensive crisis, the systolic number is higher than 180 mm Hg AND/OR the diastolic number is higher than 120 mm Hg. Take note, only one of the two blood pressure numbers have to be higher for hypertensive crisis.

I’ve dug down deep on this topic and will let you know everything you need about hypertensive crisis. It’s crucial to know about this BP category because the consequences of blood pressure in this range can be fatal or drastically change your life. High blood pressure will cause problems over time, but hypertensive crisis can cause harm in a moment. I’ll inform you about the symptoms and how to recognize who to call if your numbers get this high.

How Do You Know If Your Blood Pressure Is In Hypertensive Crisis?

As noted above, in this range the systolic (upper) number is higher than 180 AND/OR the diastolic (lower) number is higher than 120. Now listen up, because the AND/OR is extremely important. This means for your blood pressure to be in hypertensive crisis only one of the 2 numbers have to be either higher than 180 for the systolic number or higher than 120 for the diastolic number.

So if your blood pressure is 160/130, even though the systolic number is 180 or less, you’re in a hypertensive crisis because the diastolic number is higher than 120. If your blood pressure is 185/125, you’re in hypertensive crisis because both numbers are higher. In addition, if your blood pressure is 190/110, you’re in hypertensive crisis because the systolic number is higher than 180 even though the diastolic number is less than 120 (resource).

Some Signs or Symptoms Of Hypertensive Crisis

It’s possible that your blood pressure numbers are high enough to be in this range and you’re unware of it. Sometimes there may be signs or symptoms that can inform you there might be trouble. These signs can include the following:

  • Severe headache
  • Shortness of breath
  • Nosebleed
  • Severe anxiety

What To Do If You’re In Hypertensive Crisis

If you take your blood pressure and either number is higher than 180/120, wait about 5 minutes and take it again. If the 2nd reading is just as high and you are NOT experiencing any of the following below, then call your doctor immediately and be guided by what they say.

  • Chest pain
  • Shortness of breath
  • Back pain
  • Numbness or weakness
  • Change in vision
  • Difficulty breathing

If you’re not experiencing any of the symptoms above, this is considered a hypertensive urgency. A hypertensive urgency rarely requires hospitalization. Your healthcare provider may have you adjust or add medications.

If your BP readings indicate hypertensive crisis and you ARE experiencing one of the above symptoms (chest pain, shortness of breath, back pain, numbness or weakness, change in vision and difficulty breathing), call 911 immediately. Do not wait to see if your pressure comes down. I’ll say it again, if your readings indicate hypertensive crisis and you are experiencing one of the above symptoms, please call 911 immediately! This situation is known as a Hypertensive Emergency.

Hypertensive Crisis Consequences

If you ever find yourself with uncontrolled blood pressure and the symptoms noted above, the consequences can be severe (resource). This is why I stressed the importance of calling 911 or your doctor. If you delay the phone call, hoping your blood pressure will go down, the risk is too high. May your blood pressure go down, and none of these consequences happen? Sure, that’s possible, but your health is too important to take that chance. The grim consequences of uncontrolled blood pressure in this range include all the following:

  • Stroke: This is when the blood supply to the brain is interrupted.
  • Loss of consciousness: This is when you faint.
  • Memory loss: Trouble recalling information or events.
  • Heart attack: When the flow of blood to your heart is blocked.
  • Damage to the eyes & kidneys: The blood vessels in the eye retina can get damages.
  • Loss of kidney function: The arteries around the kidneys can get damaged and fail to deliver blood.
  • Aortic dissection: This is when your aorta artery develops a tear in the wall. This can cause a decrease in blood to your body’s organs or a rupture of the aorta.
  • Angina: The heart experiences a reduction in blood flow causing a severe pain in the chest. The pain might spread to your neck, shoulders or arms.
  • Pulmonary edema:This is when fluid builds up in the air spaces and tissues of the lungs. This can cause cardiac arrest or fatal respiratory distress.
  • Eclampsia: A condition that can cause a coma or seizures with pregnant women.

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hypertensive crisis

Hypertensive Crisis & The Blood Pressure Chart

There are 5 blood pressure categories in the blood pressure chart. Each category has distinctive names and numbers for the 2 types of blood pressures, systolic and diastolic. Your blood pressure numbers determine what blood pressure category your reading falls into. It’s significant to note the words between systolic and diastolic numbers, and & or. It makes an important difference whether both numbers or just one of the numbers classify the BP range. For hypertensive crisis (and/or) it can be both numbers or just one of them. The categories on the chart from least serious to serious are:

  1. Normal
  2. Elevated
  3. High Blood Pressure Stage 1
  4. High Blood Pressure Stage 2
  5. Hypertensive Crisis

How Blood Pressure Is Recorded

To understand hypertensive crisis better it’s important to know what the systolic and diastolic numbers mean. 2 numbers are recorded in two different ways to get a blood pressure reading. The 2 numbers are the upper number and the lower number. The first number or upper number is your systolic blood pressure. Systolic blood pressure indicates how much pressure your blood is exerting against your artery walls when the heart beats.

The second number or lower number is your diastolic blood pressure. Diastolic blood pressure indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats (resource). Both numbers have the abbreviation mm Hg at the end. This means millimeters of mercury. The original blood pressure monitors used mercury in a tube. Although mercury is not used in today’s common monitors, it is still used as the standard unit of measurement.

Monitor Hypertensive Crisis At Home

If you are monitoring your blood pressure at home, you want to make sure the blood pressure readings you are taking are accurate. The last thing you want to do is call your doctor or 911 for blood pressure that really isn’t high. Or for the opposite, not knowing your blood pressure is high because you’re getting lower readings. Accurate readings are the only true way to determine if your pressure is in hypertensive crisis.  

Also, a record of your blood pressure readings taken over time can help you partner with your doctor. This way you can monitor your high blood pressure and make sure any treatments you are receiving are working. While heart disease is still the No. 1 killer in the United States and around the world, death rates have decreased significantly. Earlier and better treatment of high blood pressure has played a key role in that decrease. The recent 2017 blood pressure guidelines stress the importance of accurate, at home readings. If you are interested in checking out some affordable home monitors, see the ones I recommend in my blog post.

Home Blood Pressure Monitoring Tips

  • The first thing is to make sure you have the right cuff size for your arm. If the cuff is too small, it can lead to higher readings and if it’s too big or loose, it can result in lower readings. Measure the diameter of your upper arm by wrapping a cloth measuring tape around your arm between the elbow and the shoulder. Make sure it’s snug but not too tight or loose. Take that measurement and check it against the cuff you already have or a new one you plan on buying one.
  • Before taking your blood pressure at home don’t smoke, drink caffeinated beverages or exercise within 30 minutes before taking your blood pressure.
  • Make sure you have 5 minutes of quiet rest before measuring and empty your bladder.
  • Don’t take blood pressure measurements over clothes.
  • It’s best to sit in an upright position, back straight and supported like in a dinning room chair and not on a sofa. Your feet should be flat on the floor, and your legs should be uncrossed.
  • Your arm should be supported by a flat surface such as a table or arm rest with your upper arm at heart level. Place the cuff directly above the bend of the elbow. You can check your blood pressure monitor instructions for pictures.
  • It’s important to take your blood pressure readings the same time every day such as morning or night and take your readings daily.
  • Every time you take your blood pressure readings, take 2 or 3 of them one minute apart and record all your results.
  • If your blood pressure monitor has a built-in memory to store your readings you can take it with you to your doctor appointments.
  • Be aware that home monitoring is not a substitute for regular visits to your doctor. If you have been prescribed medication to lower your blood pressure, don’t stop taking them without consulting with your doctor. Don’t stop even if your home blood pressure readings are in the normal range.

hypertensive crisis


Hypertensive Crisis Risk Factors

If you have high blood pressure, it’s extremely important to lower it. In addition to a possible hypertensive crisis, high blood pressure can lead to serious health issues like heart attack, stroke and cardiovascular disease. High blood pressure is when your blood pressure readings are too high consistently. The first category of high blood pressure, stage 1, has a systolic number of 130-139 mm Hg or a diastolic number of 80-90 mm Hg. 

High blood pressure is often called the “silent killer” because you usually don’t know you have it and there are normally no symptoms or signs. Certain physical traits and lifestyle choices can put you at a greater risk for high blood pressure (resource).

The following are risk factors related to who you are. Common hereditary and physical risk factors for high blood pressure include:

  • Age: You are more likely to get high blood pressure as you get older. As you age, your blood vessels gradually lose some of their elasticity, which can contribute to increased blood pressure.
  • Family History: If your parents or other close relatives have high blood pressure, there’s an increased chance that you can get it too.
  • Gender: Up to age 64, men are more likely to get high blood pressure than women are. At age 65 and older, women are more likely to get high blood pressure.
  • Race: African-Americans are more likely to develop high blood pressure than any other racial background in the United States.
  • Chronic Kidney Disease: High Blood Pressure may occur as a result of kidney disease. And, having HBP may also cause further kidney damage.

The following are modifiable risk factors, things you can change to help lower blood pressure:

Unhealthy Diet: Good nutrition from a variety of sources is critical for your health. A diet that is too high in calories, saturated and trans fat and sugar, carry an additional risk of high blood pressure. Making healthy food choices can actually help lower blood pressure.

Lack of physical activity: Not getting enough physical activity increases your risk of getting high blood pressure. Physical activity is great for your heart and circulatory system in general and blood pressure is no exception. Aim to get about 20-30 minutes a day.

Being Overweight or Obese: Excess weight puts an extra strain on your heart and circulatory system that can cause serious health problems. It also increases your risk of cardiovascular disease, diabetes and high blood pressure.

Excess Alcohol: Regular, heavy use of alcohol can cause many health problems, including heart failure, stroke and an irregular heartbeat. It can cause your blood pressure to increase dramatically and can also increase your risk of cancer, obesity, suicide and accidents.

High Cholesterol: More than half of the people with high blood pressure also have high cholesterol.

Smoking and Tobacco: Using tobacco can cause your blood pressure to temporarily increase and can contribute to damaged arteries overtime.

Lack Of Sleep and Sleep Apnea: Obstructive sleep apnea may increase risk of developing high blood pressure and is common in people with resistant hypertension. Lack of sleep can cause more stress throughout the day. Follow these tips to help improve your sleep:

  • Keep a consistent sleep schedule even on the days you’re not working. Going to sleep and waking up the same times every day is a great routine that helps you get better sleep.
  • Keep the temperature in the room on the cooler side. The National Sleep Foundation recommends the temperature in your bedroom to be between 60 and 67 degrees.
  • Avoid all electronics like tv, computer and cell phone 🙁 before bedtime. This stimulates brain activity and has a negative affect on sleep quality.
  • Try to keep your room as dark as possible.

Stress: Too much stress may contribute to increased blood pressure. Also, too much stress can encourage behaviors that increase blood pressure, such as poor diet, physical inactivity, using tobacco, illegal drugs or drinking alcohol more than usual.

Hypertensive Crisis Treatment


It is highly likely that if you aren’t on medication already, the doctor will prescribe blood pressure medicine after having BP that high. It’s also possible that if you’re already on medication, the doctor may change it, alter the dose or add a combination of medicines. The following are the common blood medications prescribed for BP as high as hypertensive crisis (resource):

  • Alpha blockers: Helps ease blood flow by relaxing the artery walls.
  • Ace inhibitors: Helps ease blood flow by expanding the blood vessels.
  • Beta-blockers: Lessen the amount of blood being pumped by reducing your heart rate.
  • Diuretics: Help the body get rid of excess fluids and sodium. Excess fluid increases blood volume which can increase the heart rate and make it work harder.
  • Calcium channel blockers: They openly expand your arteries and slow down your heart rate.
  • Alpha-2 receptor agonists: Helps to lower blood pressure by decreasing nervous system activity.
  • Angiotensin ll receptor blockers: They block the effects of angiotensin (a protein in the blood that causes the blood vessels to constrict which raises blood pressure) which opens up the arteries.

Lifestyle Changes

In addition to medication, the doctor is going to suggest major lifestyle changes for you. These changes can have an enormous affect on your blood pressure levels. Once your blood pressure is under control these changes should continue and become a way of life for you. Your blood pressure will not only stay lower but there’s a chance that you won’t have to take any medicine either.


Eat foods high in magnesium. Magnesium has a calming affect on the body and also your blood vessels. They allow your blood vessels to open and stay unconstricted. Magnesium can also help you sleep and stay more relaxed. There are numerous studies (resource) that show how magnesium lowers blood pressure. I wrote a blog post on a blood pressure supplement that has magnesium as one of the 3 BP ingredients. If you’re interested you can see it right here. The following are 5 foods high in magnesium:

  1. Spinach: A leafy green that tells us Popeye The Sailor may have had low blood pressure:)
  2. Pumpkin seeds: They also contain omega3 and omega 6 fatty acids.
  3. Swiss chard: A leafy green vegetable also known as silverbeet.
  4. Dark chocolate: Also has high levels of antioxidants. Dark is better than milk because it has more cacao and less sugar.
  5. Almonds: Besides magnesium, it also has vitamins, fiber and protein.

In addition to magnesium, another way to help prevent hypertensive crisis is with foods high in potassium. Potassium helps the kidneys balance the fluid in the body. Excess fluid can raise blood pressure so maintaining around 4,700 mg of potassium a day is important. Numerous studies (resource) have shown an association between low potassium levels and high blood pressure. In fact, I wrote a whole blog post on how potassium lowers blood pressure. There’s one way that might surprise you, you can check out the post right here. Foods high in potassium include:

  • Sweet potato
  • Avocado
  • Lima beans
  • Swiss chard
  • Acorn squash
  • Spinach

The problem with most people’s daily nutrition is the high amount of sodium consumed. While sodium is important and needed, most people get 3 to 4 times the amount they should be consuming. If you’re not sweating all day long at work or a highly trained athlete, you should be getting approximately 1,250-1,500 mg of sodium a day.

Avoid foods that are high in saturated fats like fatty red meats, pork, chicken skin, fried food, lamb, sausages and hot dogs. Instead eat skinless chicken, organic lean grass fed beef, salmon and halibut.

Avoid foods with added sugars like donuts, pastries, deserts, ice cream, cakes, cookies and candy. There’s strong evidence that sugar can raise your blood sugar and insulin levels. This causes an increase in the heart rate and BP because it activates your sympathetic nervous system. In addition, added sugar can increase your weight which puts you at a greater risk of high BP.

Physical Activity

Besides nutrition, getting physical activity is one of the best changes you can make to improve your health and help lower your BP. Make some time in the day to enjoy about 20-30 minutes of some form of physical activity. You don’t have to join or go to a gym, unless you want to. There are many easy ways to get the activity you need. Here are some ideas for you.

  • Walking: This can be done almost anywhere. In your neighborhood, the indoor mall or on a treadmill in your basement.
  • Jogging: Almost the same as walking, except in the mall, you can do this almost anywhere.
  • Yoga: They have many kinds of yoga for every age group or level of fitness.
  • Cardio exercise: It can be low or high intensity. Like yoga, there are all kinds for any age or fitness level.

Related Questions

What is some emergency treatment for high blood pressure at home? Emergency treatment for high blood pressure at home can include the following:

  • Call 911 and be guided by their advice.
  • Don’t panic and stay calm.
  • Sit or lay down.
  • Regulate your breathing with slow, deep breaths.
  • Keep the room temperature comfortable.

What is the difference between hypertensive crisis and hypertensive emergency? Hypertensive emergency is a subset of hypertensive crisis. A hypertensive crisis is when your blood pressure rises quickly and has a systolic BP higher than 180 mm Hg and/or a diastolic BP higher than 120 mm Hg. A hypertensive emergency is when your BP reaches those numbers and you have one of the following symptoms: chest pain, change in vision, shortness of breath, difficulty breathing, back pain, numbness or weakness.

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Kevin Garce

Kevin Garce is a Certified Health Coach who encourages people by informing them on blood pressure topics important to them. His years of research and knowledge inspire people to achieve their goals. Read more here About Me

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