A hypertensive emergency from a sudden rise in your blood pressure at 180/120 millimeters of mercury (mm Hg) or higher requires immediate care. If not treated, it can cause serious health difficulties including heart difficulties.

High blood pressure (hypertension) is when the force of blood flowing through your vessels is too high too often.

About 50% of adults in the United States live with it. When you have a sudden, large jump in your blood pressure, you may be experiencing hypertensive urgency or a hypertensive emergency. Both can cause serious health difficulties.

Both are also types of hypertensive emergencies and need immediate care. A hypertensive emergency is when your blood pressure quickly reaches 180/120 millimeters of mercury (mm Hg) or higher.

If you have hypertension, here’s how to know the difference between an urgency and an emergency and what to do.

Many things can cause a spike in your blood pressure, including exercise, anxiety, or stress. That doesn’t mean you shouldn’t pay attention.

Hypertensive urgency can be a symptom of a more serious problem or potential for difficulties down the road.

This is a sudden, severe increase in blood pressure that may put you at risk of progressive organ damage. That risk can increase if you have other conditions, such as congestive heart failure or chronic kidney disease.

You may have urgency (but not an emergency) when there isn’t evidence of organ damage such as kidney failure, neurological difficulties such as stroke, or other acute heart difficulties along with blood pressure elevation.

Doctors will use your symptoms to gauge whether a blood pressure spike is urgent or an emergency. Both need timely care.

Timely treatment is vital because untreated blood pressure at or above 180/120 mm Hg can cause:

  • eclampsia (if you’re pregnant)
  • fluid in your lungs, aka pulmonary edema
  • eye and kidney damage
  • angina
  • heart attack
  • memory loss
  • unconsciousness
  • stroke
  • a tear in your aorta, the main artery to the heart

You may or may not need to call 911 or local emergency services. You probably have urgency if you have a spike but no other symptoms. If you experience specific symptoms, you may need help immediately.

Here’s what the American Heart Association recommends if you suddenly reach a blood pressure at or above 180/120 mm Hg:

  • Wait 5 minutes and take another reading.
  • If your pressure is just as high, but you’re not experiencing symptoms of organ damage, contact a doctor or other healthcare professional right away. They may have you add or adjust medication, but you’re less likely to be hospitalized.
  • If your blood pressure is the same and you have symptoms of major organ damage, call 911 or local emergency services.

A hypertensive emergency is when blood pressure is at or above 180/120 mm Hg. When you have an increase in both numbers plus the symptoms of organ damage mentioned above, it’s an emergency.

Other symptoms of a possible emergency include the following:

  • dizziness
  • confusion
  • headache
  • trouble breathing
  • vomiting
  • less urine output
  • numbness or weakness
  • trouble speaking
  • vision changes
  • shortness of breath
  • back pain
  • chest pain

Doctors usually treat hypertensive emergencies in the emergency department. They may also admit you to an intensive care unit.

Doctors may suggest one or more treatments for chronic high blood pressure, including lifestyle changes and medication. Managing chronic hypertension also requires close monitoring.

Consult your doctor or other healthcare professional about your options for treating chronic high blood pressure.

Some changes they may recommend include:

  • tracking your blood pressure regularly
  • eating a heart-healthy diet that’s low in salt, which can worsen hypertension
  • getting regular physical activity
  • quitting smoking if you smoke
  • working with a healthcare team
  • keeping a moderate weight
  • taking medication as prescribed

Those medications may include:

The best way to avoid a hypertensive emergency is to take all your blood pressure medication as prescribed.

A 2015 Italian study looked at 622 people with hypertension who had gone to the hospital with heart failure. In the study, many hypertension medications greatly lowered the risk of heart failure in those who took their medications as prescribed. But the less regularly people took their medication, the less effective the medication was at protecting them.

Blood pressure management also includes checking your blood pressure regularly and adopting any lifestyle changes a doctors suggest. Regular checkups are essential, too.

If you have hypertensive urgency, a doctor may or may not decide to give you medication to lower your blood pressure quickly. The choice depends on which organs are affected, so consulting your healthcare team is the best option.

Some of the medications they may give you during a hypertensive emergency include:

  • sodium nitroprusside, which is short-acting
  • labetalol, an alpha-beta-blocker
  • fenoldopam, a peripheral dopamine receptor agonist
  • clevidipine, a calcium channel blocker
  • clonidine (Catapres), an alpha-agonist hypotensive agent, by itself or in combination with other blood pressure medications

If you have high blood pressure and it spikes to 180/120 mm Hg, you may be experiencing hypertensive emergency. It may be hypertensive urgency that a doctor can help you treat without hospitalization, or it could be a hypertensive emergency requiring immediate medical treatment.

The difference between the two is that urgency doesn’t involve symptoms of organ damage.

The best way to prevent a hypertensive emergency is to manage your blood pressure closely and take all medication as prescribed.