What should you be vigilant about when blood pressure suddenly spikes?

Many hypertensive patients have probably experienced this: suddenly feeling dizzy or having a headache, nausea, and vomiting, then checking their blood pressure and being shocked to see a reading of 180mmHg. What’s more alarming is that some patients discover they have hypertension in this way.
So, what causes a sudden increase in blood pressure? Is it necessary to go to the emergency room?

Blood Pressure Fluctuates Normally

Blood pressure is controlled by the autonomic nervous system of the human body and adjusts itself with daily activities, diet, exercise, and emotions. Under physiological conditions, daytime systolic and diastolic pressures are usually 10%-20% higher than during sleep; in the early morning, as one transitions from sleep to wakefulness, blood pressure shows a significant upward trend.

This significant increase in blood pressure in the early morning is known as
morning surge in blood pressure. Studies have shown that the majority of hypertensive patients have a more pronounced increase in blood pressure during the early morning hours compared to those with normal blood pressure, with over 60% of patients experiencing a surge in blood pressure of more than 25mmHg. The morning surge in blood pressure is often one of the important causes of sudden increases in blood pressure.

Common Causes of Sudden Blood Pressure Spikes

Intake of a large amount of sodium in a short period (such as consuming a large amount of pickled foods, various heavy口味 oily foods during holidays);
Emotional excitement;
Engaging in intense physical activity;
Behaviors that can easily lead to excessive sympathetic nervous system excitement, such as smoking and drinking alcohol;
Insufficient sleep at night or nocturnal hypoxia caused by sleep apnea;
Hypertensive patients who have been on long-term medication suddenly stop or forget to take their medication (especially beta-blockers like metoprolol and bisoprolol).

What are the serious impacts of elevated blood pressure?

When blood pressure rises and remains above a certain critical level, it triggers a series of local and systemic effects, causing vascular damage and further increases in blood pressure, leading to damage to organs such as the heart, brain, eyes, kidneys, and arterial vessels. In severe cases, it can rapidly threaten life.

If the sudden hypertension is accompanied by damage to the aforementioned organs, it is referred to as hypertensive emergency, which requires urgent medical treatment.

Which situations indicate possible organ damage?

Hypertension occurring after acute brain trauma or injury;
Accompanying symptoms of the nervous system such as agitation, coma, and convulsions;
Accompanying signs of stroke such as limb weakness, sensory abnormalities, speech disorders, and asymmetric facial expressions;
Blurred vision, double vision, or other visual impairments;
Nausea and uncontrollable projectile vomiting;
Chest discomfort;
Sudden severe back pain;
Difficulty breathing;
Sudden increase in blood pressure during pregnancy;
Use of specific medications, such as cocaine, amphetamines, or monoamine oxidase inhibitors.

Home Care Methods

After discussing the above situations, some readers may feel very frightened by the sudden increase in blood pressure, but there is no need to worry too much. In fact, it is more common for patients to have a noticeable increase in blood pressure without clues of the serious organ damage mentioned above, and they may only have a mild headache or no discomfort at all. What should be done in such cases?

Studies have found that 32% of asymptomatic hypertensive patients (with blood pressure above 180/110mmHg at emergency visits) will experience a spontaneous decrease in blood pressure by at least 20/10mmHg after resting quietly for 30 minutes in an environment with the curtains closed and free from noise interference.
.Therefore, resting in a dimly lit, quiet environment is the first home care measure that should be taken by patients with sudden hypertension without the above symptoms of organ damage.

Note that the rest mentioned here refers to absolute rest, not lying down and playing with a smartphone or continuing to think about problems.

How to Make Up for Missed Medications?

Missing medication is also a common cause of sudden increases in blood pressure. The commonly used antihypertensive drugs are long-acting, and only need to be taken once a day. Missing 2-3 days does not necessarily cause significant fluctuations in blood pressure. In such cases, there is no need to make up for the missed dose; just continue taking the medication at the original dosage.

If you forget to take your medication and your blood pressure rises significantly, you can decide whether to make up for the missed dose based on the time since the last dose. If the current time is closer to the time you were supposed to take the medication and further from the next scheduled time, you can take one dose, and then take the next dose as scheduled.

If the current time is closer to the next scheduled medication time, you can still take one dose to make up for the missed medication, but the next medication time should be postponed accordingly to gradually return to a regular medication schedule. However, you should not take the doses for both times at once, as this may cause a drop in blood pressure leading to cardiovascular and cerebrovascular accidents.

If your blood pressure does not decrease after resting quietly and you have not missed any antihypertensive medications, you can use some short-acting antihypertensive drugs for temporary management of significantly elevated blood pressure. Common oral short-acting antihypertensive drugs include captopril, furosemide, etc. In this case, it is recommended to visit the emergency room or outpatient clinic and take medication according to the doctor’s orders.
Note that it is not recommended to use ordinary nifedipine tablets (not slow-release nifedipine) as a short-acting antihypertensive drug, as it may cause uncontrollable blood pressure drops.

Last but not least, it is important to remind every hypertensive patient that if there is a sudden increase in blood pressure, it is necessary to pay attention to whether there has been long-term poor blood pressure control. Even after home care and emergency treatment, and the blood pressure has returned to normal, it is recommended to visit a cardiologist or family doctor to adjust the corresponding antihypertensive medications to achieve the goal of blood pressure control.

References:

1.Uptodate: Evaluation and treatment of hypertensive emergencies in adults

2.Uptodate: Management of severe asymptomatic hypertension (hypertensive urgencies) in adults

3.Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure. American College of Emergency Physicians. Ann Emerg Med. 2013;62:59-68

Disclaimer:

This article has been reviewed by the Zhuozheng Medical Advisory Board. The purpose of the article is to provide general health information and cannot replace any individual’s medical diagnosis and treatment. Personal medical issues need to be discussed and consulted with a doctor. For any suggestions on this popular science article, you can email: medicine@distinctclinic.com.

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