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This page addresses concerns regarding high blood pressure in the emergency department only. It does *** NOT *** apply to high blood pressure at home / in the community, especially longstanding hypertension.

Is my high blood pressure abnormal?
Yes. Having a systolic/diastolic above 140/90 (either number) is considered abnormal. However, high blood pressure is also a normal response to pain, discomfort, anxiety, or simply being in an unfamiliar environment. Blood pressure also rises naturally when exercising. It is common to see high blood pressure in the emergency department – it is not usually a cause for concern as patients are in the department for reasons that will cause blood pressure to rise.

Is high blood pressure bad for me?
Yes. We know this because statistics show that over the long term (years to decades), having a high blood pressure reading throughout the day and night will increase the risk of having a stroke (part of brain dies permanently), heart attack (part of heart dies permanently), and serious complications such hypertensive retinopathy (blindness), renal failure (kidney failure) etc.

Is high blood pressure ever treated in the ED?
Yes. In the setting of a bleeding in to the brain, or if there is evidence of end organ damage (kidneys, heart, eyes). Blood pressure control in ED (and ICU) is very specific and targeted. We use a special cannula (similar to a regular drip) that is inserted to an artery (not vein. usually the wrist.) to get a real time blood pressure reading. It is a significantly invasive and painful procedure. This arterial cannula is then stitched into the skin. We then use a large drip into a big vein to give powerful drugs that can force a patient’s blood pressure to come down by suppressing/slowing the heart, or widening blood vessels in the arms and legs.

Why is ** my ** blood pressure not being treated in ED?
Treatment of high blood pressure is a long term issue that requires slow up-titration (increment) of anti-hypertensive medications. The maximal effect of these oral medications can take days to weeks to stabilize. As mentioned earlier, your blood pressure readings may not be abnormal at home – for example, when you wake up at 2am to use the bathroom. Overtreating blood pressure is extremely dangerous. It can cause fainting and falls – eg. it is a known cause of elderly patients falling and breaking their hip. The real question is what your average blood pressure is at home and when you are well. Many patients in ED will have an elevated blood pressure as part of a normal stress response – from pain/discomfort or just being in an unfamiliar, noisy environment. The second risk of treating blood pressure in an ED setting is that we often do not know how long standing the high blood pressure has been an issue for. There are some people who are getting about their normal lives with elevated blood pressure, often above 180 (systolic / the higher number). A sudden drop in blood pressure by over 30 percent, say from 180 down to 120 can cause a stroke whereby the brain is starved of oxygen and dies due to lack of blood supply (it had adjusted to having a high blood pressure over many years). In the setting of long term high blood pressure over months, GPs will often attempt to lower blood pressure slowly over weeks to months and avoid complications such as lightheadedness when standing (falls risk). It is very risky to start blood pressure treatment in ED for the above reasons.