what is considered stroke-level high blood pressure?
A reading of 180/120 mm Hg or higher is considered a hypertensive crisis and requires immediate medical attention.

According to the American Heart Association (AHA), a reading of 180/120 mm Hg or higher is termed a hypertensive crisis and requires immediate medical attention. If this reading is consistent two times in a row, five minutes apart, then you must head to the nearest emergency room immediately.

Blood pressure (BP) is the force applied against the walls of the arteries by the blood that the heart pumps through the four chambers into major arteries that transport blood throughout the body through the circulatory system.

According to the AHA, normal BP in adults is 120/80 mm Hg. However, according to the new guidelines issued by the AHA, the goal BP for all adults is now less than 130/80 mm Hg.

According to guidelines by the American College of Cardiology/American Heart Association, hypertension is a term to describe high BP that measures consistently above 130/80 mm Hg or higher.

Hypertension affects one-third of Americans and is a considerable risk factor for cardiovascular diseases such as heart attack and heart failure, stroke, renal diseases, and death.

What causes hypertension?

Hypertension is often called a “silent killer” because it may cause no noticeable symptoms.

It can be a result of the following:

  • Age (blood pressure increases with age)
  • Gender (men are more likely to develop hypertension than women)
  • Family history
  • Unhealthy lifestyle (lack of exercise, sedentary lifestyle and consumption of junk and processed foods are modifiable factors)
  • Excessive salt intake
  • Decreased or no physical activity
  • Obesity
  • Diabetes
  • High cholesterol
  • Stress
  • Pregnancy
  • Alcohol consumption
  • Smoking

What is a hypertensive crisis?

Depending on the severity, a hypertensive crisis is divided into two types, including:

  1. Hypertensive urgency: It is an elevation of blood pressure (BP) more than 180/120 mm Hg with no associated symptoms. In this condition, you can wait for five minutes and then take the readings again. If the recordings are the same, seek medical help immediately.
  2. Hypertensive emergency: This stage requires immediate medical attention and hospitalization. It is defined as severe high BP that exceeds 180/120 mm Hg, along with the presence of acute target organ injury with symptoms such as


How to Lower Blood Pressure: Exercise Tips See Slideshow

What are the stages of hypertension?

According to the American Heart Association recommendation, the stages are as follows:

Table. The stages of hypertension
Blood pressure category Systolic (mm Hg) Diastolic (mm Hg)
Normal Less than 120 Less than 80
Prehypertension 120 to 129 Less than 80
Hypertension stage I 130 to 139 80 to 89
Hypertension stage II 140 or above 90 or above
Hypertensive crisis More than 180 More than 120

Why should you go to the ER for high blood pressure?

When blood pressure (BP) readings are high enough to indicate a hypertensive crisis, this pressure can damage blood vessels and can lead to severe complications, including:

  • Stroke: Increased strain on blood vessels can cause an ischemic stroke (a blood clot) or a hemorrhagic stroke (blood vessels to burst) within the brain, causing a stroke.
  • Loss of vision: High BP can cause ischemic optic neuropathy (blockage of blood flow to the eye), resulting in damage to the optic nerve and potential vision loss.
  • Heart attack: Blockage of arteries results in a heart attack.
  • Heart failure: Excessive strain on the heart leads to inefficient pumping of the blood, resulting in heart failure.
  • Aneurysm: The pressure exerted can lead to an aortic aneurysm (bulging of the aorta).
  • Pulmonary edema: Pressure from the strained heart pushes fluid through the blood vessel walls into the lungs.
  • Kidney failure: Consistent pressure leads to narrowing and hardening of the arteries around the kidneys, thus reducing the amount of blood delivered to the kidneys.

How to treat hypertension

Treatment of hypertension needs a multipronged approach including:

  • Diet changes:
    • Decreased salt intake
    • Avoid oily, junk, and processed foods
    • Increased foods with potassium content such as papaya and oranges
  • Lifestyle modifications:
  • Medications:
    • Diuretics (water pills): Helps get rid of excess water and salt through urine
    • Angiotensin-converting enzyme (ACE) inhibitors: Widens or dilates the blood vessels to improve the amount of blood pumped by the heart
    • Angiotensin receptor blockers (ARBs): Same effects as ACE inhibitors
    • Beta-blockers: Blocks the effects of the sympathetic nervous system
    • Calcium channel blockers: Prevents the influx of calcium into the cells of the heart and blood vessel walls, thus relaxing the vessels and heart muscles

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Medically Reviewed on 12/15/2021
Image Source: iStock Images

Severe Asymptomatic Hypertension American Family Physician: https://www.aafp.org/afp/2017/0415/p492.html

Understanding blood pressure readings: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

Things you need to know about blood pressure and hypertension NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560868/

Hypertensive Crisis: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/hypertensive-crisis-when-you-should-call-911-for-high-blood-pressure