Hypertensive Crisis
A blood pressure of 180/120 represents a hypertensive crisis or hypertensive urgency. If there are no associated symptoms, the situation is urgent. Symptoms of chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking point to a crisis with more damage. A pressure this high can cause a stroke any time. The most critical thing is to get the pressure down. Make an adjustment to the blood pressure medicine and follow the patient closely. Someone on your team should be checking with a patient like this very frequently until the pressure is at a much safer level. Adjustments can be made frequently until a safer pressure level is achieved. It may take up to 4 medications to achieve control. Home blood pressure measurement and phone calls or texts can help
Lowering the top number on the blood pressure by just 10 points or 10 mm/Hg, lowers the risk of stroke by over 25%. Often patients will protest that they don’t want to take more medication. I would answer them like this. “Pressures this high are very dangerous. We must get your pressure down to protect you. If you have a stroke you may never be the same. Let’s get your pressure down and make you safe. Then we have time to cut back on salt and lose weight. Maybe we can cut down on your medication then.” Poor blood pressure control is a problem we can easier improve with teams, protocols, and systems. Let’s do it.