Hypertensive Crisis: How Does it Happen?

Hypertensive crisis is a hypertensive emergency. This means that when the blood pressure of a patient spikes to more than average, to the point that it causes problems in the eyes, brain, kidneys or heart. It can sometimes also lead to permanent organ damage if not attended well in time.

Blood pressure is measured in mm Hg, short for millimeters of mercury. Less than 120/80 mm Hg is considered normal BP for a healthy body. The top value, i.e 120, is known as systolic blood pressure and the lower value, i.e. 80, is known as diastolic blood pressure.

When your heart beats, this is the highest level your blood pressure should reach. When your heart relaxes in between two beats, this is the lowest level of blood pressure it should ideally achieve.

Blood pressure is determined by how much blood is pumped in the body and the resistant force of this blood in the arteries. Hypertension would mean that this force of blood against your arteries will eventually lead to issues like cardiovascular diseases.

According to the American Heart Association, in a hypertensive crisis, your blood pressure can rise up to 180/120 mm Hg or higher. This article will talk about how to know if you have hypertensive urgency or hypertensive emergency, what symptoms to look out for, how to take care when in a hypertensive crisis, and when to contact the doctor immediately.

What is hypertensive urgency?

Hypertensive urgency is when your blood pressure rises up to 180/120 mm Hg, but no signs of organ damage are visible. These signs are heavy breathing, chest pain, shortness of breath, blurred vision, back pain, severe headache, or slurred speech. Hypertensive urgency  Hypertensive urgency requires immediate attention, but doesn’t necessarily require hospitalization.

This condition can be taken care of with the help of medications and healthy habits over a period of time. If your blood pressure reading reaches 180/120 mm Hg, take another reading after five minutes. If it lowers a bit, then you might be having hypertensive urgency.

Consult your doctor before popping a pill or consuming any high-sodium foods.

What is a hypertensive emergency?

Hypertensive emergency is the most dangerous situation that requires immediate attention or can be fatal. It is a rare condition and can happen if the patient has been irregular with their hypertension medication or was not aware of his/her blood pressure issues in the first place.

Hypertensive emergency means that the blood pressure has reached the 180/120 mmHg mark, and remains constant even after checking twice or thrice. This BP range is so high that it can possibly lead to organ damage.

The damages can be grouped into 4 based on the organs affected:

Eyes: Sudden loss or blurring of vision due to the bleeding at the back of the eye. 

Brain: Sudden loss of consciousness, sensory deficits, weakness, and confusion, more likely due to a swelling or bleeding in the brain or brain stroke. 

Kidneys: When kidneys fail due to high pressure, it might cause difficulty breathing because of pulmonary edema, swelling of the legs, and passage of bloody urine. 

Heart: Hypertensive crisis can also lead to heart failure, heart attack, or aneurysm or damage to major blood vessels. 

Having consistent hypertensive urgency that lasts a few hours combined with the symptoms of targeted organ damage can potentially lead to a hypertensive emergency.

If you are already a hypertension patient and also taking other medications, consult your doctor about how the combination of these pills might affect your blood pressure. Or if you are going to different doctors, let them know about your hypertension.

What are the symptoms of a hypertensive crisis?

If your blood pressure remains 180/120 mm Hg consistently, even after checking two to three times, getting immediate medical attention is required.

Bringing this blood pressure down with tablets may be difficult and other means may have to be used. Consult your doctor right away if you’re experiencing any or some of the following symptoms related to a hypertensive emergency:

1. Shortness of breath
2. Severe headache
3. Blurry vision
4. Confusion and difficulty talking
5. Increasing and repeated chest pains
6. Seizures or passing out
7. Nose bleeding
8. Weakness or numbness on one side of the body, or in one arm or leg
9. Nausea or vomiting
10. Slurred speech
11. Passing out urine that is brown or bloody
12. Sweating

Remember that the above-mentioned symptoms may not subside even by taking blood pressure medicine and often need to be treated with intravenous medicines.

Hypertensive crisis treatment

For hypertensive urgency: In all possible cases, your doctor will either add a medication to your list or adjust the dosage of the existing ones. If this is your first experience with high blood pressure, it is a sign for you to be regular with your medication. In extremely rare instances will hypertensive urgency require hospitalization. Therefore, carefully monitoring your blood pressure for uniformity will help.

For hypertensive emergency: Since this indicates probable organ damage, the treatment for a hypertensive emergency is more intense. It would require immediate hospitalization with regular blood pressure monitoring, blood and urine tests as well as eye examinations to look for swelling or bleeding due to high blood pressure.

An intravenous (IV) medication will be used to lower and bring the blood pressure down to a healthy parameter. However, recovery is tricky and would need thorough diligence with medication, eating habits, psychological balance, and exercise thereafter.

When should you seek immediate medical attention?

Some classic signs of hypertensive crisis include difficulty in breathing or shortness of breath or hyperventilation, excessive and non-stop sweating, severe and pounding headache, increasing chest pains, blurry vision, slurred speech, and confusion. If you know that you have high blood pressure and you have any of the symptoms listed above, seek medical attention immediately.

Also, remember that a healthy blood pressure range is below 120/80 mm Hg. If you see it rising or moving towards the higher side, speak to your doctor. Do not wait for it to reach a potential 180/120 mm Hg, which can be fatal if not treated in time.

Staying regular with your medications, practicing healthy eating habits, exercising only till your body can take it, and meditating to keep anxiousness at bay are some factors, which can help prevent a hypertensive crisis. Do not take or combine any two medicines on your own, consult your doctor about the best way forward.

Learn more about hypertension here.