Last week, we reviewed what a hypertensive crisis is and when to seek urgent help. Today, we’ll take a closer look at what causes these dangerous spikes in blood pressure, how doctors determine whether organ damage is occurring, and how hypertensive crises are treated.
What Are the Causes of Hypertensive Crisis?
A hypertensive crisis can happen for several reasons. Common causes include:
Undiagnosed and/or untreated high blood pressure- Missing doses of blood pressure medication – This is one of the most frequent triggers.
- Suddenly stopping blood pressure medication – Some medications, especially beta-blockers or clonidine, can cause a rebound spike if stopped abruptly.
- Severe stress or anxiety
- Drug interactions or stimulants – Including cocaine, amphetamines, certain decongestants, and NSAIDs (nonsteroidal anti-inflammatory drugs).
- Kidney disease – If the kidneys aren’t functioning well, blood pressure can rise quickly.
- Hormonal conditions – Such as thyroid disorders or adrenal gland tumors.
- Pregnancy-related complications – Including preeclampsia and eclampsia.
Sometimes, no clear cause is found, but medication issues remain the most common cause.
How Can Your Doctor Tell If You Have Organ Damage?
When someone arrives with very high blood pressure, the first priority is determining whether organs are being harmed. Your doctor may check for:
- Heart strain or blood vessel damage – By doing a thorough cardiovascular exam, an EKG, blood tests, and possibly imaging of the heart and blood vessels.
- Brain involvement – By doing a neurological exam, and CT or MRI scan of the brain.
- Kidney injury – By doing blood and urine tests to assess kidney function.
- Eye damage – By doing an eye exam to look for bleeding or swelling in the retina.
These tests help distinguish hypertensive urgency from hypertensive emergency, which guides treatment.
How Are Hypertensive Crises Treated?
Treatment depends on whether organ damage is present.
- Hypertensive Urgency – Usually treated with oral medications and close follow-up. Hospitalization is usually not required.
- Hypertensive Emergency – Requires immediate treatment in the ER, and sometimes hospital admission. It is usually treated with IV medications and continuous monitoring. The goal is to lower blood pressure safely (not too fast) to protect vital organs.
How Can You Reduce Your Risk?
- Take blood pressure medications exactly as prescribed – If you have a side effect from a medication, or you can’t afford the medication, always call your doctor for guidance on what to do. Don’t wait until your next appointment! Your doctor wants you to call in these situations.
- Never stop medications suddenly without consulting your doctor.
- Monitor your blood pressure regularly at home.
- Follow heart-healthy habits such as the DASH diet, regular activity, and limiting sodium.
- Keep all follow-up appointments.
Hypertensive crisis is serious, but with good blood pressure control and awareness of warning signs, it is often preventable.
If you have any questions about hypertensive crisis, please log into your account and send us your question. We are here to help.
Dr. Anita Bennett MD – Health Tip Content Editor