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Hypertensive Crisis


What is a hypertensive crisis?

A hypertensive crisis is a sudden spike in blood pressure to 180/120 or higher. It is also known as acute hypertension. A hypertensive crisis is a medical emergency. It could lead to organ damage or be life-threatening.

What increases my risk for a hypertensive crisis?

  • Failure to take your blood pressure medicine as directed by your doctor.
  • Hypertension caused by pregnancy (preeclampsia, eclampsia)
  • Thyroid disease, kidney or adrenal disease, heart disease, or stroke
  • Cocaine or amphetamine use
  • Cigarette smoking or alcohol abuse
  • Burns, head injuries, surgery, or trauma

What are the signs and symptoms of a hypertensive crisis?

  • Blurred vision or headache
  • Nausea or vomiting
  • Shortness of breath or chest pain
  • Dizziness or weakness
  • Problems with thinking or behavior changes, such as sleepiness, forgetfulness, or confusion

How is a hypertensive crisis diagnosed?

Your healthcare provider will ask if you have health conditions, such as high blood pressure, diabetes, or heart disease. He will ask what your symptoms are and if you have ever had surgery. Tell him what medicines you take and if you have ever used illegal drugs. Your healthcare provider will check your blood pressure on both arms and listen to your heart and lungs. He will examine your eyes closely and also test your strength, balance, reflexes, and memory. The following tests may be done to check for damage to your heart, brain, and kidneys:

  • Blood tests are done to find out if your liver and kidneys are functioning properly.
  • Urine tests are done to check your kidneys.
  • An EKG is used to monitor your heart. Sticky pads placed on your skin record your heart's electrical activity.
  • A chest x-ray is a picture of your lungs and heart. A chest x-ray may show signs of heart failure or fluid around your heart and lungs.
  • A CT scan is also called a CAT scan. An x-ray machine uses a computer to take pictures of your head. The pictures may show signs of a stroke. You may be given dye before the pictures are taken to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.

How is a hypertensive crisis treated?

Treatment depends on the cause of your hypertensive crisis. Healthcare providers will lower your blood pressure and try to prevent organ damage. You may need the following:

  • Blood pressure medicine is given to lower your blood pressure. There are many different types of blood pressure medicine, and you may need more than one type.
  • Diuretics help decrease extra fluid that collects in your blood vessels. This lowers your blood pressure by reducing pressure in your arteries. Diuretics are often called water pills. You may urinate more often while you take this medicine.

What are the risks of a hypertensive crisis?

Even with treatment, you are at risk for a heart attack, stroke, or kidney damage. You could develop a bulge or tear in the wall of your aorta (the artery that supplies blood throughout your body). Fluid could collect in your lungs and make it hard for you to breathe. You are at risk for blindness, eye damage, seizures, as well as brain damage.

How can I help prevent another hypertensive crisis?

  • Manage other health conditions such as diabetes, thyroid disease, or adrenal problems. These conditions can cause or worsen a hypertensive crisis.
  • Take your blood pressure at home while in a seated position. Take it at least twice a day, such as morning and evening. Keep a log of your blood pressure readings and bring it to your follow-up visits.
  • Eat a variety of healthy foods including fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. You will need to limit how much sodium and fat you eat. You also may need to eat more potassium. Ask if you need to be on a special diet. Changes to your diet will help lower your blood pressure.
  • Ask your healthcare provider if you are at a healthy weight. Ask him to help you create a weight loss plan if you are overweight. Even a little weight loss can help lower your blood pressure.
  • Ask your healthcare provider about the best exercise plan for you. Exercise may help lower your blood pressure.
  • Limit alcohol to 1 drink a day if you are a woman. A man should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
  • Do not smoke. Smoking causes heart disease and may also raise your blood pressure. If you smoke, it is never too late to quit. Ask your healthcare provider for information if you need help to quit smoking.

Where can I find support and more information?

  • American Heart Association
    7272 Greenville Avenue
    Dallas , TX 75231-4596
    Phone: 1- 800 - 242-8721
    Web Address:

When should I contact my healthcare provider?

  • You run out of medicine.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You take your blood pressure and it is 180/110 or higher.
  • You have a severe headache.
  • You have chest pain or shortness of breath.
  • You have weakness or numbness in your face, arms, or legs.
  • You cannot see or talk as well as usual.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.