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.
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.
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.
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
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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.