What Is Extremely High Blood Pressure?

What Is Extremely High Blood Pressure?

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Taking prescribed blood pressure medication reduces the risk for a hypertensive emergency.

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Doctors define extremely high blood pressure as a blood pressure reading of 180 over 110 mm of mercury -- mmHg -- or higher. One or both numbers of the blood pressure reading may be in the critical range with extremely high blood pressure. All the different types of extremely high blood pressure are serious and require immediate medical evaluation, even if you have no symptoms. Emergency treatment is sometimes needed to prevent potentially life-threatening complications.

Types of Extremely High Blood Pressure

Extremely high blood pressure is divided into two main categories: severe asymptomatic hypertension and hypertensive emergency. These conditions are distinguished by signs or symptoms of organ damage. With severe asymptomatic hypertension, the blood pressure is extremely high but signs or symptoms of organ damage are absent. Someone with a hypertensive emergency has extremely high blood pressure combined with signs or symptoms of organ damage related to the elevated blood pressure.

Severe Asymptomatic Hypertension

Severe asymptomatic hypertension usually develops in people who have uncontrolled high blood pressure. Because signs or symptoms are lacking, some people may have severe asymptomatic hypertension when they are first diagnosed with high blood pressure. In other cases, the situation develops because of ineffective treatment or not taking prescribed blood pressure medicines. People with severe asymptomatic hypertension need to see a doctor right away to determine if risk factors, such as heart disease or poor kidney function, could lead to progression to a hypertensive emergency. If these risk factors are present, doctors often term the situation "hypertensive urgency," which is an intermediate condition between severe asymptomatic hypertension and a hypertensive emergency.

Hypertensive Emergency

In a hypertensive emergency, extremely high blood pressure damages internal organs, causing signs and symptoms. The brain, heart, kidneys, eyes and lungs are often affected. Symptoms may include shortness of breath, chest or abdominal pain, confusion, drowsiness, weakness, headache, vision problems and seizures. Blood tests often reveal abnormal kidney function. Other tests, such as a chest x-ray, CT scan and electrocardiogram, are often used to diagnose the extent of organ damage. A stroke, heart attack or tearing of the artery that takes blood from the heart to the body may occur during a hypertensive emergency.


People experiencing a hypertensive emergency require hospitalization, often in the intensive care unit. Intravenous medications are used to gradually bring the blood pressure under control over hours to days. Health-care professionals monitor closely during this time, watching for possible complications. Although immediate evaluation is needed with severe asymptomatic hypertension, inpatient treatment in a hospital is usually not necessary. Oral blood pressure medication is used to bring the blood pressure under control over weeks to months. Frequent visits to the doctor's office may be needed during this time for close monitoring of blood pressure.


If you check your blood pressure at home and get an extremely high reading, call your doctor right away. If you experience symptoms that may indicate a hypertensive emergency, seek care at the nearest emergency room. Getting emergency help quickly reduces the risk of serious, long-term organ damage or a life-threatening complication.

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