• Shruti GOCHHWAL

Hypertensive Crisis: What To Do When Your Heart Rate Crosses 180 bpm?

Severe uncontrolled blood pressure leads to organ damage. When you have blood pressure, you must keep checking the levels periodically. Imagine a situation when your heart rate crosses 180 bpm. In this article, we are discussing how Hypertensive crisis emergencies are managed.

What is Hypertension?

Hypertension is a chronic medical condition that requires optimum management. About 33% urban and 25% of rural Indians are hypertensive.

Hypertension is an established risk factor for cardiovascular, cerebrovascular, and kidney diseases. Elevated blood pressure can cause severe organ damage with significant morbidity and mortality.

What are the Causes of Hypertension?

A high salt diet causes blood pressure

Pickles, Credits: pixabay


The lack of physical activity, obesity, family history of high blood pressure, age, race, a diet rich in salt and fat, certain medications, and chronic medical conditions are the main causes of hypertension.

What are Hypertensive Urgency and Hypertensive Emergency?

Hypertensive crisis

Heart rate, Credits: pixabay


Hypertensive crisis is classified as hypertensive urgency and hypertensive emergency. It is important to distinguish the category and accordingly treatment plan should be initiated.

Hypertensive urgency is a condition when the blood pressure readings are 180/110 or higher, but there is no damage to the body’s organs. Within a few hours, the blood pressure readings can be brought down with medications.

Hypertensive emergencies happen in 1 to 2% of hypertensive cases. Hypertensive emergencies can happen when the blood pressure is so high, such that organ damages can occur. Blood pressure needs to be reduced immediately to prevent organ damage in an intensive care facility. Hypertensive emergencies are rare and it usually happens when hypertension is left untreated or if the person has taken over-the-counter-medicines that resulted in increased blood pressure.

What are the Symptoms of Hypertensive Emergencies?

Hypertensive Emergency-Symptoms

Confused man, Credits: pixabay


The following signs and symptoms are seen in a hypertensive emergency.

Headache and blurred vision

Chest pain

Shortness of breath

Confusions and seizures

Swelling and edema due to buildup of fluid in the tissues.

How to Manage Hypertensive Emergencies?

Hypertensive Emergency-Management

A doctor taking a blood pressure reading, Credits: pixabay


  1. At entry, dyspnoea, chest pain, and headache were the most frequent symptoms in both hypertensive urgency and hypertensive emergency conditions. The most frequent organ damage in hypertensive emergencies is stroke, pulmonary edema, and coronary syndrome.

  2. Hypertensive emergency is best managed with continuous infusion of a short-acting, titratable antihypertensive agent.

  3. The patients are managed in an ICU with close monitoring and accurate BP readings are measured.

  4. The goal of the treatment is not to lower the BP rapidly, but to reduce the mean arterial pressure.

  5. If the patient remains stable after treatment, a further reduction to 160/110mmHg is aimed over the next 2 to 6 hours.

  6. Based on the patient’s response to treatment, normalization of BP levels will be planned with oral agents in the next 24 to 48 hours.

What are the Common Drugs to Treat Hypertensive Crisis?

Drugs to treat Hypertensive Emergency

Drugs, Credits: pixabay


The following drugs are used to treat hypertensive emergencies.DrugsCategoryMechanism of ActionDuration of ActionEsmolol

 Beta-adrenergic receptor blocker60 seconds10 to 20 minutesFenoldopamDopamine-1 receptor agonist

Within 5 minutes30 minutesLabetalolNonselective beta-adrenergic and selective alpha-adrenergic receptor blocker2 to 5 minutes after IV administration, peak at 5 to 15 minutes.3 to 6 hoursNicardipineSecond-generation dihydropyridine calcium channel blocker 5 to 15 minutes40 to 60 minutesNitroglycerinPotent venous dilator1 to 2 minutes5 to 10 minutesNitroprusside Potent arterial and venous vasodilatorWithin seconds1 to 2 minutes

Take-Home Message

Hypertensive emergencies are rare. It is important to take the prescribed medications for hypertension to avoid hypertensive emergencies.

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