Understanding The Categories and How Physicians Think About Them
Updated June 30, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
There are different categories of high blood pressure; depending on the category that you fall into helps to determine how your health care provider thinks about treating your blood pressure. Two that we talk about in this post include hypertension emergency and hypertension urgency.
* Hypertension Emergency: This is a really high blood pressure in which the patient has symptoms that can be attributed to the high blood pressure.
The blood pressure is usually greater than 180/100 mmHg. Some of these symptoms include:
* Chest Pain. The high blood pressure can be a cause of chest pain or angina. The extremely high blood pressure can be a cause of the anginal pain and can be a cause of a heart attack in some individuals. Anginal pain is typically reported as being substernal chest pressure; the pressure can travel or "radiate" to the arms and or jaw. Remember that women may not present with the typical symptoms of chest pain; their presenting symptoms can be as nonspecific as nausea, vomiting, or generalized weakness and fatigue.
* Congestive Heart Failure (CHF): This can cause you to develop acute shortness of breath. The very high blood pressure can cause fluid to acutely buildup in the lungs, also referred to as pulmonary edema. This is commonly diagnosed by symptoms but also the presence of fluid in the lungs on a chest x-ray.
* Aortic Aneurysm Dissection (Rupture): This can occur in anyone who has had uncontrolled high blood pressure for a long time, often for months to years.
The most common symptom is acute onset of back pain; a sharp, shearing pain that that can present either in your upper back (the thoracic or "chest" aortic dissection) or your lower to mid back (the abdominal aortic dissection). This is an acute emergency that requires immediate treatment including the acute lowering of the blood pressure.
Note: if you are a male between the ages of 50-74 and you have a history of high blood pressure, it is recommended that you have an ultrasound done to evaluate for a possible aneurysm. High blood pressure in and of itself is a risk factor for the development of an aneurysm.
* Stroke and Bleeding: Uncontrolled high blood pressure can be a cause of an acute stroke. It can also be a cause of an intracerebral bleed ( bleeding in the brain). Doctors will usually order an imaging study such as a CT scan or MRI of the brain to further evaluate to see if a stroke occurred.
* Confusion: Uncontrolled high blood pressure can be a cause of acute confusion. This condition is called hypertensive encephalopathy. An acute stroke is also a diagnostic consideration in this situation. The confusion due to the very high blood pressure resolves with lowering of the blood pressure.
Hypertensive Urgency: This is a situation where the blood pressure is elevated, but there are no focal symptoms. The blood pressure is usually no higher than 180/120 mmHg. Often the blood pressure has been elevated for some time, and your doctor will talk about treating the high blood pressure, usually with a medication. The goal is to lower the blood pressure gradually over a period of several weeks. If your blood pressure has been elevated at this level and you have no symptoms (i.e., chest pain, shortness of breath, dizziness, lightheadedness, double vision) if your blood pressure is then acutely lowered, you may experience the above symptoms.
As you can see, paying attention to symptoms is key in dealing with high blood pressure.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
There are different categories of high blood pressure; depending on the category that you fall into helps to determine how your health care provider thinks about treating your blood pressure. Two that we talk about in this post include hypertension emergency and hypertension urgency.
* Hypertension Emergency: This is a really high blood pressure in which the patient has symptoms that can be attributed to the high blood pressure.
The blood pressure is usually greater than 180/100 mmHg. Some of these symptoms include:
* Chest Pain. The high blood pressure can be a cause of chest pain or angina. The extremely high blood pressure can be a cause of the anginal pain and can be a cause of a heart attack in some individuals. Anginal pain is typically reported as being substernal chest pressure; the pressure can travel or "radiate" to the arms and or jaw. Remember that women may not present with the typical symptoms of chest pain; their presenting symptoms can be as nonspecific as nausea, vomiting, or generalized weakness and fatigue.
* Congestive Heart Failure (CHF): This can cause you to develop acute shortness of breath. The very high blood pressure can cause fluid to acutely buildup in the lungs, also referred to as pulmonary edema. This is commonly diagnosed by symptoms but also the presence of fluid in the lungs on a chest x-ray.
* Aortic Aneurysm Dissection (Rupture): This can occur in anyone who has had uncontrolled high blood pressure for a long time, often for months to years.
The most common symptom is acute onset of back pain; a sharp, shearing pain that that can present either in your upper back (the thoracic or "chest" aortic dissection) or your lower to mid back (the abdominal aortic dissection). This is an acute emergency that requires immediate treatment including the acute lowering of the blood pressure.
Note: if you are a male between the ages of 50-74 and you have a history of high blood pressure, it is recommended that you have an ultrasound done to evaluate for a possible aneurysm. High blood pressure in and of itself is a risk factor for the development of an aneurysm.
* Stroke and Bleeding: Uncontrolled high blood pressure can be a cause of an acute stroke. It can also be a cause of an intracerebral bleed ( bleeding in the brain). Doctors will usually order an imaging study such as a CT scan or MRI of the brain to further evaluate to see if a stroke occurred.
* Confusion: Uncontrolled high blood pressure can be a cause of acute confusion. This condition is called hypertensive encephalopathy. An acute stroke is also a diagnostic consideration in this situation. The confusion due to the very high blood pressure resolves with lowering of the blood pressure.
Hypertensive Urgency: This is a situation where the blood pressure is elevated, but there are no focal symptoms. The blood pressure is usually no higher than 180/120 mmHg. Often the blood pressure has been elevated for some time, and your doctor will talk about treating the high blood pressure, usually with a medication. The goal is to lower the blood pressure gradually over a period of several weeks. If your blood pressure has been elevated at this level and you have no symptoms (i.e., chest pain, shortness of breath, dizziness, lightheadedness, double vision) if your blood pressure is then acutely lowered, you may experience the above symptoms.
As you can see, paying attention to symptoms is key in dealing with high blood pressure.
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