That blood pressure in isolation isn’t an emergency, it’s what it can be indicating or causing beneath the surface that’s the emergency. There are people walking around every day with SBP >180 that have no idea they have high blood pressure.
High blood pressure over years and years will damage blood vessels, the heart, kidneys, etc… This is what we call end-organ damage meaning that the blood pressure had injured an organ over time. There’s also something called hypertensive encephalopathy where you are confused because your blood pressure is high (essentially end organ damage to the brain). So if you show up in an ER with that blood pressure we might check your kidney function and a some basic heart tests but as long as you’re not exhibiting damage to an organ system, we’ll send you on your way with instructions to see your doctor.
Now, you can also have high blood pressure as the result of something else. Kidney stone? Broken bone? Yeah, your pressure will be up but pain control will fix that. Other more serious stuff, like a blood clot type of stroke can push up your pressure because your body is trying really hard to get blood flow to an area of the brain that isn’t getting good flow. Also, high blood pressure in pregnancy or right after can be a sign of eclampsia and should be aggressively treated or can cause death or disability.
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