In this article you will learn when you may need hospitalization for high pressure, what to expect when you get hospitalized for high blood pressure, and why it is important to seek emergency care when your blood pressure is too high.
When do you need to be hospitalized for high blood pressure?
Normally, high blood pressure is something you treat by taking pills prescribed by your regular doctor. You then need regular follow-up appointments, and your doctor will adjust your medication based on your blood pressure.
However, there are certain situations when you need to be hospitalized for high blood pressure. Sometimes, your regular doctor will send you to the hospital out of concern. At other times, you may visit the emergency department for some concerning symptoms and the ER doctor gets you hospitalized for dangerously high blood pressure.
When you have dangerously high blood pressure, you need urgent evaluation by a doctor. Dangerously high blood pressure has been arbitrarily defined as blood pressure higher than 180/120. The upper number is called systolic blood pressure and the lower number is called the diastolic blood pressure. Any one of the two numbers above that threshold is considered dangerously high blood pressure. However, research has not definitely proven that this cutoff is accurate. The higher your blood pressure is, the more concerned your doctors will be. You will not be automatically hospitalized if you meet those numbers.
The most important factor your doctor will use when deciding hospitalization is the presence of so called “end organ damage.” High blood pressure may cause problems with multiple organ systems in your body. Dangerously high blood pressure may actually damage one of these vital organs if not treated urgently.
There are four major organs that may be damaged by dangerously high blood pressure:
- Brain
- Eyes
- Heart
- Kidneys
We will visit each one in detail.
Signs and symptoms of brain damage from dangerously high blood pressure
If you have any of the following symptoms together with dangerously high blood pressure, you will need hospitalization to protect your brain from further damage:
- Significant new dizziness
- Uncontrolled nausea and vomiting
- New onset confusion and disorientation
- Signs and symptoms suggesting a stroke
Signs and symptoms suggesting a stroke is a vast topic and I suggest you visit the American Stroke Association for details. I have included a link to the specific page in the reference material listed at the end of this webpage. In the meantime, continue reading about other organs that may be damaged form dangerously high blood pressure and what symptoms to look for when you are concerned about organ damage.
Signs and symptoms of damage to the eyes from dangerously high blood pressure
You may have blood vessels inside your eyes burst open and bleed when your blood pressure is dangerously high. You may also have a significant swelling of nerves inside your eyes.
If you have any of the symptoms along with dangerously high blood pressure, you will need hospitalization to prevent further damage to your eyes:
- Sudden onset blurry vision
- Sudden blindness
- Appearance of floaters
- Distorted vision
Signs and symptoms of damage to the heart from dangerously high blood pressure
You may have a heart attack, heart ischemia (lack of blood flow to the heart; less severe than a heart attack), heart failure (inability of the heart to effectively circulate your blood) and other damages to your heart when you have dangerously high blood pressure.
If you have any of the following signs, symptoms or test findings, you will need hospitalization:
- Chest pain
- Chest tightness or heaviness
- Shortness of breath
- Fainting or feeling like you are fainting
- Blood test suggesting damage to the heart muscles
- EKG (an electrical tracing of the heart) findings that suggest heart ischemia
- Chest x-ray suggesting new swelling and fluid accumulation in the lungs
Signs and symptoms of damage to the kidneys from dangerously high blood pressure
Damage to the kidneys from dangerously high blood pressure can be somewhat difficult to detect based on symptoms alone. You need a combination of signs, symptoms, blood tests, and urine tests to look for kidney damage from dangerously high blood pressure.
Here are some of the possible findings:
- Bloody urine, with plenty of red blood cells seen when examined under a microscope
- Frothy urine, with presence of significant amounts of protein when tested in the lab
- Blood tests showing high amounts of toxins and waste products in the blood as a result of the kidneys not filtering them properly
- Unable to make adequate amounts of urine
What to expect when hospitalized for high blood pressure
You will most likely be monitored in the ICU when you are hospitalized for high blood pressure with concerns about possible organ damage. You can expect to have the following treatments and monitoring:
- Intravenous blood pressure lowering medications as an IV drip
- Heart monitor
- CT scan of the head
- Multiple EKGs
- Frequent blood tests
- Multiple IV lines
The most important aspect of treating dangerously high blood pressure in the hospital is not to bring it down too fast. That may surprise you because it goes against your intuition. Knowing you have dangerously high blood pressure, you may think that you need to lower it fast. However, lowering very high blood pressure too fast can be more dangerous. The sudden drop in pressure may cause more damage to the organs at risk. That is why you need very close monitoring of your blood pressure. They will adjust your blood pressure medication slowly and watch the effects closely.
It is generally recommended to not lower your blood pressure more than 25% in the first hour. After that, they recommend keeping your blood pressure slightly below the danger threshold for the next 24 hours. After 24 hours, blood pressure can be lowered to normal, but it is not necessary to do so in the hospital. Once the blood pressure is down to an acceptable label, you can safely go home. You will continue to adjust your blood pressure safely during your regular doctor visits.
When is high blood pressure an emergency? When to go to the emergency room for high blood pressure?
When you need to go to the emergency room for high blood pressure is different from when you need to be hospitalized for high blood pressure. As you read earlier, organ damage from dangerously high blood pressure can sometimes be difficult to know based on symptoms alone. You may need a blood test, urine tests, and an EKG to look for any potential organ damage when you have dangerously high blood pressure.
Anytime you check your blood pressure and it is above the cutoff of 180/120, you need to at least call your doctor and let you doctor decide if you need to go to the emergency room. If you have any of the concerning symptoms such as chest pain, dizziness, lightheadedness, shortness of breath, bloody urine, frothy urine, blurry vision, or severe headaches along with dangerously high blood pressure, you need to call 911 and ask for help.
Here are some of the complications that may happen if you do not get timely treatment for dangerously high blood pressure with concerning symptoms:
- Major heart attack
- Major stroke
- Major bleeding inside the brain
- Blindness
- Kidney failure
- Aortic dissection: Major life-threatening tear of the aorta
In conclusion, dangerously high blood pressure may need hospitalization for proper evaluation and treatment. It is very helpful to understand what to expect when you get hospitalized for high blood pressure. You don’t want to ignore dangerously high blood pressure because the consequences could be dire.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711750/