Blood Pressure EmergenciesWhen to Call 911

If you're currently experiencing a medical emergency, call 911 immediately. Don't delay seeking help to read this page.

Most of the time, high blood pressure is a chronic condition managed through lifestyle changes and medication. But sometimes blood pressure rises to dangerous levels that require immediate medical attention. Knowing when to call 911 could save your life or someone else's.

A hypertensive emergency occurs when blood pressure is so high that it's actively damaging organs. This is different from simply having high blood pressure—it's an acute crisis requiring emergency treatment to prevent stroke, heart attack, kidney failure, or death.

Call 911 Immediately If...

Call emergency services right away if you have blood pressure above 180/120 mmHg along with any of the following symptoms:

Stroke Signs

  • Sudden severe headache (worst of your life)
  • Sudden confusion or trouble speaking
  • Sudden numbness or weakness, especially on one side
  • Sudden vision problems in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance

Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911

Heart Attack Signs

  • Chest pain or pressure (may spread to arm, jaw, back)
  • Shortness of breath
  • Cold sweats
  • Nausea or vomiting
  • Lightheadedness

Note: Women may have subtler symptoms like fatigue, back pain, or indigestion

Other Emergency Signs

  • Severe chest or back pain
  • Severe difficulty breathing
  • Seizures
  • Unresponsiveness or altered consciousness
  • Vision loss or severe vision changes
  • Blood in urine (with high BP)
  • Severe anxiety with feeling of doom

Understanding Hypertensive Crisis

A hypertensive crisis is divided into two categories based on whether organ damage is occurring:

Hypertensive Urgency

Blood pressure is severely elevated (typically above 180/120 mmHg) but there are no signs of immediate organ damage. You may have no symptoms at all, or mild symptoms like headache or anxiety.

This still requires prompt medical attention—usually within hours—but isn't a call-911 emergency. Contact your healthcare provider immediately or go to urgent care. Blood pressure will typically be lowered gradually over 24-48 hours.

Hypertensive Emergency

Blood pressure is severely elevated AND there are signs of acute organ damage—to the brain, heart, kidneys, or blood vessels. This is a true emergency requiring immediate treatment in a hospital, typically in an intensive care unit.

Conditions that may occur during a hypertensive emergency include:

  • Stroke: Blocked or bleeding blood vessel in the brain
  • Heart attack: Blocked blood flow to heart muscle
  • Acute heart failure: Heart suddenly unable to pump effectively
  • Aortic dissection: Tear in the main artery from the heart (severe chest/back pain)
  • Eclampsia: Seizures in a pregnant woman with preeclampsia
  • Acute kidney injury: Sudden loss of kidney function
  • Hypertensive encephalopathy: Brain swelling causing confusion, seizures
  • Retinal hemorrhage: Bleeding in the eyes, vision loss

What to Do While Waiting for Help

If you've called 911 for a blood pressure emergency, take these steps while waiting:

  1. Stay calm. Anxiety can raise blood pressure further. Take slow, deep breaths.
  2. Sit or lie down in a comfortable position. Don't stand—you could fall if you faint.
  3. Loosen tight clothing around your neck and waist.
  4. Don't eat or drink in case you need emergency surgery.
  5. If prescribed, take nitroglycerin for chest pain (only if already prescribed for you).
  6. Don't drive yourself to the hospital—wait for the ambulance or have someone else drive.
  7. Gather your medications (or have someone do so) to show paramedics.
  8. Unlock the door so paramedics can enter easily.

Do NOT:

  • Take extra doses of blood pressure medication unless specifically instructed by a medical professional
  • Put anything in the mouth of someone having a seizure
  • Give aspirin unless you're certain it's a heart attack (aspirin can worsen certain strokes)
  • Leave someone alone who is having symptoms

What If My Reading Is High But I Feel Fine?

Severely elevated blood pressure (above 180/120 mmHg) without symptoms is still serious but may not require calling 911.

If you get a very high reading:

  1. Wait 5 minutes and recheck. Make sure you're measuring correctly—seated, relaxed, proper cuff position.
  2. If still high, wait another 5-10 minutes and measure again. Anxiety from the first reading can elevate the second.
  3. If readings remain above 180/120 mmHg and you have no symptoms, call your healthcare provider immediately for guidance.
  4. If you can't reach your provider, consider going to urgent care or the emergency room.
  5. If symptoms develop at any point, call 911 immediately.

Don't ignore severely elevated readings even without symptoms. Organ damage can occur silently, and what starts as hypertensive urgency can progress to emergency.

Preventing Hypertensive Emergencies

Most hypertensive crises are preventable with proper blood pressure management:

  • Take medications as prescribed. Stopping blood pressure medications suddenly is a common cause of hypertensive crisis. Never stop without consulting your provider.
  • Monitor at home. Regular monitoring catches rising blood pressure before it becomes critical.
  • Keep appointments. Regular check-ups allow your provider to adjust treatment as needed.
  • Know your warning signs. Learn what symptoms require urgent attention.
  • Manage stress. Acute stress can trigger blood pressure spikes.
  • Avoid triggers. Certain substances (cocaine, amphetamines, excessive caffeine, some supplements) can cause dangerous blood pressure spikes.
  • Control other conditions. Keep diabetes, kidney disease, and other conditions well-managed.

After a Hypertensive Emergency

If you've experienced a hypertensive emergency, your ongoing care becomes even more important:

  • Your medications will likely change. You may need different or additional blood pressure medications.
  • More frequent monitoring is essential. Your provider may want you to check blood pressure daily and report results.
  • Understand what triggered the crisis—missed medications, a new medication interaction, substance use, or an underlying condition.
  • Follow up closely with your healthcare provider. You may need more frequent visits initially.
  • Address any organ damage. If the crisis affected your heart, kidneys, or brain, additional treatment and rehabilitation may be needed.

Frequently Asked Questions

Is 180/120 always an emergency?

Blood pressure of 180/120 mmHg or higher is always serious and requires attention. It becomes a true emergency when symptoms of organ damage are present. Without symptoms, it's considered hypertensive urgency—still serious, but typically managed less aggressively than a full emergency. Either way, don't ignore readings this high.

Should I take extra blood pressure medicine if my reading is very high?

No, not unless specifically instructed by a medical professional in that moment. Taking extra doses on your own can cause blood pressure to drop too quickly, which can be dangerous—especially if you're having a stroke. Call your provider or 911 instead of self-adjusting medications.

Can stress alone cause a hypertensive emergency?

Extreme stress can trigger significant blood pressure spikes, and in rare cases, these can reach emergency levels. More commonly, stress acts as a trigger in someone whose blood pressure is already poorly controlled. If you have hypertension, stress management is an important part of prevention.

How quickly does blood pressure need to be lowered in an emergency?

Not too quickly. Paradoxically, lowering blood pressure too fast during an emergency can cause more harm by reducing blood flow to vital organs that have adapted to higher pressure. In most emergencies, the goal is gradual reduction—typically no more than 25% in the first hour, then gradually to normal over 24-48 hours. This is why emergency treatment requires hospital monitoring.

I've had high readings before without problems. How do I know this time is different?

The presence of symptoms makes the difference. If you have symptoms suggesting organ damage—severe headache, chest pain, vision changes, neurological symptoms, severe shortness of breath—treat it as an emergency regardless of what happened in the past. Each hypertensive episode is a roll of the dice; previous luck doesn't guarantee future safety.