Hypertensive Crisis: What to Watch For and What to Do

A hypertensive crisis happens when blood pressure shoots to dangerously high levels — usually a systolic (top) reading of 180 mmHg or higher or a diastolic (bottom) reading of 120 mmHg or higher. Not every high reading is a crisis. The difference is whether the body shows signs of damage to organs like the heart, brain, kidneys, or eyes. If you or someone near you has a severe spike, quick action matters.

Key signs that it's an emergency

Worried you might be dealing with a hypertensive emergency? Look for these red flags:

- Chest pain or pressure, which could mean the heart is struggling.

- Shortness of breath or coughing up frothy sputum.

- Sudden severe headache, confusion, trouble speaking, sudden weakness or numbness on one side — signs of a stroke.

- Sudden vision changes or loss of vision.

- Reduced urine output or visible blood in urine, which suggests kidney involvement.

- Severe anxiety, nausea, vomiting, or seizures.

If any of these signs appear with very high blood pressure, treat it as a hypertensive emergency and get immediate medical help.

What to do right away

First steps are simple but can make a big difference. If someone is conscious and breathing, have them sit down and stay calm. Loosen tight clothing and avoid physical activity. If you have a home blood pressure monitor, check and record the reading. Call emergency services if readings are at or above 180/120 with any of the serious symptoms listed above.

Do not try to force a rapid drop in blood pressure at home with multiple doses of medication unless a doctor specifically instructed you to. Dropping blood pressure too fast can harm the brain and other organs.

At the hospital, clinicians decide if it's an emergency or an urgency. In an emergency, IV medications such as labetalol, nicardipine, or nitroprusside may be used under close monitoring to lower pressure gradually over hours. In hypertensive urgency — very high numbers but no organ damage — oral meds and closer outpatient follow-up are common. Tests like ECG, blood tests, and imaging may be done to check for complications.

How do you lower the odds of a crisis? Stay on prescribed blood pressure meds, check your blood pressure at home regularly, cut back on sodium, limit alcohol, keep a healthy weight, and manage stress. If you miss doses or feel side effects, call your doctor rather than stopping meds abruptly. Regular follow-up is especially important if you have diabetes, kidney disease, or heart disease.

If you ever face a sudden severe readout or alarming symptoms, call emergency services right away. Quick, measured action protects the heart, brain, and kidneys — and that makes all the difference.