Hypertensive crisis occurs when a person’s blood pressure surges to an unusually high level. This condition can cause damage to blood vessels and major organs.

This article looks at some causes of hypertensive crisis and some treatment options available.

It also outlines some lifestyle factors that may help lower a person’s blood pressure and reduce their risk of experiencing hypertensive crisis.

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Healthcare providers assess blood pressure using a blood pressure monitor, or sphygmomanometer. This tool produces a reading based on two types of blood pressure: systolic and diastolic.

Systolic pressure refers to the pressure inside blood vessels as the heart forces blood out to the rest of the organs. Diastolic pressure refers to the pressure inside blood vessels as the heart rests between beats. Blood pressure is measured in millimeters of mercury (mm Hg).

A sphygmomanometer displays the systolic pressure reading above the diastolic pressure reading. If a person has a normal blood pressure, for example, the monitor will display a systolic pressure of less than 120 mm Hg over a diastolic pressure of less than 80 mm Hg.

Hypertension occurs when a person’s blood pressure exceeds normal values. There are two stages of hypertension: stage 1 and stage 2.

Stage 1 hypertension will produce a reading of 130–139 mm Hg over 80–89 mm Hg. Stage 2 hypertension, which is a more severe form, will produce a reading of 140 mm Hg or higher over 90 mm Hg or higher.

According to the Centers for Disease Control and Prevention (CDC), around 45% of adults in the United States have hypertension. They also estimate that only 1 in 4 adults have their hypertension under control.

Uncontrolled hypertension can lead to a sudden and severe increase in blood pressure. This increase is known as hypertensive crisis.

A person who is experiencing hypertensive crisis may have a systolic pressure reading of 180 mm Hg or higher and a diastolic pressure reading of 120 mm Hg or higher.

There are two types of hypertensive crisis: hypertensive urgency and hypertensive emergency.

Hypertensive urgency occurs when a person has the readings above but no associated symptoms. Hypertensive emergency occurs when a person has the readings above as well as the associated symptoms described below.

Around 1–2% of adults with hypertension will experience hypertensive crisis. Some people will experience symptoms, while others will not.

Hypertensive crisis can damage blood vessels and major organs. In 2018 alone, nearly half a million deaths in the U.S. had hypertension as a primary or contributing cause.

The American Heart Association (AHA) note that the following lifestyle and medical factors may increase the likelihood of hypertension:

The following factors are commonly associated with hypertensive crisis:

  • not taking, or forgetting to take, prescribed blood pressure medications
  • taking medications that interact with each other in a way that increases blood pressure
  • using illegal drugs, such as cocaine or amphetamines
  • having a life threatening cardiovascular condition, such as a stroke or heart attack
  • experiencing organ failure, such as heart or kidney failure

Some people experiencing hypertensive crisis may have symptoms, while others may not have any symptoms at all.

People who are able to check their own blood pressure may see a reading of 180 mm Hg/120 mm Hg or greater. If no other symptoms are present, the AHA recommend waiting 5 minutes and taking another reading. If the reading is still high, the person should contact their healthcare provider for further advice.

If their blood pressure is high and the person is also experiencing one or more of the following symptoms, someone should call 911 immediately:

A healthcare provider will take a number of blood pressure readings and ask the person about their symptoms and medical history. They will also ask about any medications or supplements the person is taking and whether or not they have used any recreational drugs.

If the healthcare provider suspects that there is a risk of organ damage due to hypertensive crisis, they will arrange for further tests. These may include:

The first-line treatment for hypertensive crisis will typically be intravenous antihypertensive medications to lower the person’s blood pressure. Healthcare providers usually aim to reduce blood pressure by no more than 25% in the first hour, as rapid decreases in blood pressure can cause other problems.

Once a person’s blood pressure is under control, the healthcare provider will usually switch to using oral antihypertensive medications.

The medications a healthcare provider uses to lower blood pressure may differ according to several factors, including:

  • whether or not the person is pregnant
  • whether or not the person has an underlying health condition
  • whether or not hypertensive crisis occurred due to the use of illegal drugs

The most important thing that a person with hypertension can do to prevent hypertensive crisis is to take their blood pressure medications exactly as prescribed.

A 2015 study found that people who often did not take their blood pressure medications were more likely to be hospitalized for heart problems.

Below are some lifestyle changes that people can make to help lower their blood pressure and reduce the risk of experiencing hypertensive crisis.

Eat a healthful diet

A healthful diet is one that is rich in fruits, vegetables, and fiber and low in fat and salt. Lowering salt intake can directly lower blood pressure.

The National Heart, Lung, and Blood Institute devised the Dietary Approaches to Stop Hypertension (DASH) eating plan for people looking to lower their blood pressure. This is a calorie controlled, heart-healthy eating plan that does not require any special foods.

Cut down on alcohol

Limiting alcohol intake to the recommended levels will help lower blood pressure and improve overall health.

The 2020–2025 Dietary Guidelines for Americans recommend that adults avoid or limit their intake of alcohol. According to the guidelines, men should consume no more than two drinks per day, while women should consume no more than one drink per day.

Keep physically active

Getting regular exercise helps keep the heart and circulatory system healthy. It can also help people lose excess weight, which can also help lower high blood pressure.

The CDC recommend that people aim to do 150 minutes of moderate aerobic activity, or 75 minutes of vigorous aerobic activity, each week. However, these figures may vary from person to person.

Avoid smoking

Smoking raises a person’s blood pressure and increases the risk of experiencing cardiovascular issues, such as heart attack and stroke.

People who smoke may wish to talk with their healthcare provider for advice on how to quit.

Get enough sleep

Good sleep is important to overall health, but it is especially important for the heart and circulatory system. This is because blood pressure drops during sleep.

Adults should aim to get at least 7 hours of sleep each night. The following factors can help improve a person’s sleep hygiene:

  • getting plenty of physical activity during the day
  • waking up and going to sleep at the same time each day
  • following a consistent bedtime routine
  • ensuring that the sleeping environment is cool, dark, comfortable, and free from noise and other distractions

Hypertensive crisis occurs when blood pressure rises to an unusually high level of 180 mm Hg/120 mm Hg or higher.

A person experiencing hypertensive crisis may or may not experience any symptoms. However, without treatment, the condition can damage blood vessels and major organs.

Factors that can give rise to hypertensive crisis include not taking antihypertensive medications, interactions between certain medications, and the use of illegal drugs. Certain underlying health conditions can also trigger hypertensive crisis.

However, there are some steps a person can take to lower their blood pressure and reduce the risk of experiencing hypertensive crisis. These steps include following a healthful diet, reducing alcohol intake, and quitting smoking.

Anyone who would like further advice about lowering their blood pressure may wish to book an appointment with their healthcare provider.