this post was submitted on 07 Jun 2026
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High blood pressure alone is not an emergency. Definitely something to be concerned about preventing/treating in the long term, but no blood pressure number alone warrants an ambulance without also having symptoms of something like a heart attack or stroke that indicates organ damage.
That said, that kind of blasé approach to markedly elevated blood pressure with no real plan to reassess or find a root cause is still unacceptable, especially lazily blaming it on menstruation like is so common. So not trying to undermine your experience, I just had to chime in bc the “hypertensive crisis” thing is a pet peeve of mine.
Idk, I'd say a blood pressure of 300/200 or 50/20 would warrant an ER ambulance trip, even without symptoms
I guess we could argue at what point it is no longer physically possible to be asymptomatic with an extremely high blood pressure, but to date there is no evidence to support the treatment of the blood pressure number alone in the acute setting.
Low blood pressure is a separate issue, but also only really treated if causing issues for a patient; however similarly, one questions the plausibility that a patient could be properly perfusing their organs and therefore have no other signs/symptoms of organ damage with a mean arterial pressure of ~30 mm Hg.
I think once I got near that level post dialysis and had no symptoms...
Until the moment I stood up. Then it was all the symptoms.
Likewise, I haven't have 300/200, but did have 200+/150+, and didn't have symptoms... Until I went to try to sleep for the night.
That's the issue with your premise. It's reactionary treatment rather than preventative, and from personal experience preventative is much more pleasant.
But I suppose in the USA the standard for example is reactionary treatment due to healthcare only being private and the insurance companies not wanting to pay up.
I know it feels wrong, but the data supports outpatient management of asymptomatic high blood pressure.
And the European Society of Cardiology agrees with the AHA, so it’s not just an American thing. Check out section 10, or ctrl+F “hypertensive urgency”.
I know of that, but that's usually after a quick check up and checking both arms plus pulse. Because if a person usually doesn't have that high of a pressure and hasn't gone through any excitatory activity, then they're at risk of stroke or cardiac failure, especially if the pressures vary between arms by over 25 points. It's the stroke and cardiac failure risk why high blood pressure is in part called the silent killer - you can live asymptomatically but then the long term effects can get you (more so if the case is extreme).
In which case, you'd want to be able to quickly administer some kind of fast acting medication (usually injected to lower it), which a person can't do at home, and then monitor them for awhile before prescribing them a standard high blood pressure medication and a follow up with a general doctor, and depending on future results then do more tests like an ultrasound.
Asymptomatic doesn't mean things are okay. There's many diseases that are asymptomatic or at least not overtly symptomatic (as in, the patient can't tell they actually have a symptom until after it's been treated and they then notice the difference) but ideally you'd actually treat them before they're symptomatic. Circulatory problems being one of them. Another being hyper cancers and certain organ failures like kidney and liver failure.
50/20 is just about my normal resting.
You're pretty short aren't you? 😅
No comment.
It's alright. You're still both short and very healthy (assuming you've achieved that via pure exercise and don't have a condition). Statistically you're likely to live a long life. Usually until late 90s
I'm not short. I'm not that healthy.
Yeah this very much depends on the actual specific number. I work inpatient so I don't blink at 155 systolic because we're gonna take it again in 12h and honestly these days the hospitalist says current evidence supports not even treating emergently until 170. The ED actually keeps insisting that 180 isn't their problem for patients they want admitted to psych. A small dentists office might not be up to date on current best practice for treating hypertension.
When I interviewed for a CSU they were even like "how would you approach an intake where your new pt has a BP of 180?" and I, coming from the university hospital where I had residents subject to my whims I struggled to come up with an answer that wasn't "page the oncall I guess?" But I did manage "...tell them to take some deep breaths and take it again...?" which was apparently the right answer???
150s to me is a GP/PCP's problem 3 months from now and ultimately they'll probably just tell the person to start with eating less salt. It also sounds like it was asymptomatic and there's also the possibility that the doctor just figured she wouldn't take anything anyway based on this person's description.
No seriously, there is no number that you need to treat emergently without accompanying signs of end-organ damage. The AHA recommends considering “permissive hypertension” even for SBPs over 180. So you could be 220/180 and if no other symptoms or signs of organ damage, you should get treated the same as someone who is 145/95, and even then that’s only if the hypertension is chronic. The only difference is it will probably take a lot more meds to chronically control someone whose bp is that extreme.
AHA’s 2024 review article for reference
Yeah >180 is definitely serious, I may have overstated myself there trying to make my point. If you read that high, it’s recommended to contact your doctor asap, but not to seek emergency treatment unless you’re having symptoms.
Current (but limited) evidence actually suggests some harm caused by unnecessarily treating asymptomatic markedly elevated blood pressure, and low risk of acute (hours to days) adverse events caused directly by the hypertension.
I’m a PharmD who works in the ED at a large teaching hospital. I have this conversation often.
Recommendations from the AHA directly to patients/lay persons
A great “Things We Do For No Reason” article about the topic. (There’s even one article in this paper that specifically talks about patients with systolic >220, only 0.2% of which had a negative vascular outcome at 7 days without inpatient treatment.) I highly recommend this paper. The folks at SHM/JHM do great work with this series.
Thanks for sharing, always so nice when people who actually know what they are talking about chips in!
I was hospitalised before by ambulance purely for a hypertensive crisis and heart palpitations, no other concerning symptoms. Magnesium infusion sorted it out, felt so much better after that.
It came out of nowhere, couldn't sleep due to heart palpitations so I checked BP and it was wildly high along with pulse. Root cause was essentially C677T homozygous SNP, taking methylated folate and b12, and trimethylglycine helps a lot and prevents further episodes
Yeah, heart palpitations would be a great example of a symptom associated with markedly elevated bp that indicates you should be treated emergency. I’m glad you got effective treatment.
Every lady's experience in a red state. Seriously, I'm not making a joke, being a "conservative" as defined in the US political system NEEDS to be categorized as a mental disorder that precludes people from being doctors at the least.
There are so many misogynists in the center (we don't have a real left) that the orange idiot beat two women.
I mean, beating Hillary was semi-predictable given all her baggage, but beating Harris was ... quite a sad display of how shitty the US is.