What Is the Most Common Cause of Hypertensive Crisis?

Hypertensive crisis is estimated to account for 3% of all emergency department visits. Risk factors include:

• Male gender
• Age (people ages 40-50 are more prone to developing the condition)
• Lifestyle (high-sodium diet, alcohol use, and substance abuse)
• Pregnancy-related diseases
• Anemia
• Diabetes
• Dyslipidemia
• Cardiovascular and renal comorbidities

A sudden spike in blood pressure indicate a hypertensive crisis:

• Hypertensive urgency (over 180 mmHg or 110-120 mmHg)
  • May not have end-organ damage but a gradual blood pressure reduction over hours or days is indicated.
  • Untreated hypertensive emergencies can develop because chronically high blood pressure can cause end-organ damage.
• Hypertensive emergency (over 180-220 mmHg or 120-130 mmHg)
  • End-organ damage to the cerebrovascular, cardiovascular, or renovascular systems that begins or progresses.
  • Blood pressure should be checked frequently to avoid catastrophic organ damage and done over minutes to hours.

Hypertensive urgency typically does not cause symptoms other than high blood pressure and possibly a mild headache.

Hypertensive emergency, however, may cause one or more of the following symptoms in addition to high blood pressure:

• Headache
• Loss of consciousness
• Confusion, agitation, or seizures
• Nausea or vomiting
• Numbness or weakness
• Blurry vision
• Fainting
• Chest pain or discomfort
• Shortness of breath
• Back pain
• Red-colored urine

Your doctor will take your medical history to determine whether you have any underlying conditions, history or surgery, or are currently on any medications. They will also measure your blood pressure on both arms several times to determine whether you are in hypertensive crisis. Tests may include:

• Blood or urine tests: To assess whether your liver and kidneys are functioning properly (high blood pressure can damage the kidneys)
• Electrocardiography: To check for any abnormal electrical activity due to hypertensive crisis in the heart
• X-ray or computed tomography scan: May be ordered if your doctor suspects end-organ damage

Hypertensive crisis is a medical emergency that requires immediate attention. Treatment options include measures to reduce stress and lower blood pressure via intravenous or oral medication. 

The immediate goal of treatment is to gradually lower blood pressure to a safe level. Target blood pressure and the rate at which it should be reduced will vary depending on the cause, severity of symptoms, and overall condition of the patient.

Treatment may include:

• Rest: If a person is experiencing hypertensive crisis without other symptoms or organ damage, simply sitting in a quiet room and resting may help lower blood pressure.
• Oral medications: If a person is experiencing a hypertensive crisis without other symptoms or organ damage, or if blood pressure has already been lowered with medications administered, oral medications may be recommended to maintain lower blood pressure.
• Intravenous medications: Medications may be administered intravenously to reduce blood pressure levels faster.

In some cases, patients must be treated in intensive care with a continuous infusion of a titratable short-acting antihypertensive drug. The goal is to reduce blood pressure by no more than 25% in a short period of time.

Potential complications of a hypertensive crisis include:

• Heart attack
• Stroke
• Bulge or tear in the wall of the aorta, which can cause fluid to  collect in the lungs and make breathing difficult
• Seizures
• Brain damage
• Kidney damage

Hypertensive crisis may be prevented with the following measures:

• Monitor blood pressure at home daily, noting readings and discussing them with your doctor weekly
• Take medications as prescribed for conditions such as diabetes
• Ask your doctor about current medications, as some drugs can increase blood pressure levels
• Limit your intake of sodium and potassium
• Exercise regularly to maintain a healthy weight
• Reduce stress
• Limit alcohol
• Quit smoking