Hypertensive Emergency

Key facts

• A hypertensive emergency is a sudden, severe rise in blood pressure, typically above 180/120 mmHg, together with signs of acute damage to the heart, brain, kidneys or eyes.
• It differs from a hypertensive urgency, where pressure is just as high but no organ damage has occurred yet.
• Warning signs include a severe headache, blurred or double vision, chest pain, shortness of breath, confusion or reduced urine output.
• Treatment happens in hospital, usually with an intravenous medicine such as labetalol, given to lower pressure gradually rather than all at once.

Warning signs that need immediate attention

A severe headache, blurred or double vision, chest pain, shortness of breath, confusion, or reduced urine output alongside a very high blood pressure reading is a medical emergency. Any combination of these calls for an emergency department visit without delay. Do not try to lower blood pressure quickly at home: an abrupt drop can itself cause harm, since organs that have adjusted to the higher pressure can be starved of blood flow when it falls too fast.

How it is treated

In hospital, intravenous agents such as labetalol bring pressure down in a controlled, gradual way over hours rather than minutes, because dropping it too fast risks a stroke or reduced blood flow to the heart. Doses are adjusted continuously against readings taken every few minutes until the level stabilises. Once the crisis has passed, longer-term management moves to ongoing heart and blood pressure care, with regular monitoring to catch a recurrence early and adjust daily medicines.

When to seek help

Call emergency services or go to an emergency department immediately if a very high reading comes with any of the warning signs above, chest pain, severe headache, vision changes, confusion or breathlessness among them. Do not wait to see whether it settles on its own, and do not attempt to self-treat with extra doses of your usual blood pressure medicine at home.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.