When Should You Call An Ambulance?

A very high blood pressure reading can feel terrifying—especially because most people with hypertension feel completely normal.

This guide will help you decide what to do **in the moment**, without minimizing risk or causing unnecessary panic.

**Important:** This is general education, not a substitute for medical care. If you think you’re having a medical emergency, call 911.

Key takeaways

• A “crisis-level” blood pressure is typically **over 180/120**.
• If you have crisis-level BP **with symptoms**, call 911.
• If you have crisis-level BP **without symptoms**, recheck correctly and contact your clinician promptly for guidance.

What counts as a hypertensive crisis?

A commonly used threshold is:

• **Systolic (top number) > 180** and/or
• **Diastolic (bottom number) > 120**

But the number alone is not the whole story. Symptoms and organ involvement matter.

Hypertensive emergency vs. “severely high BP”

Clinicians often separate crisis-level readings into two scenarios:

1) Hypertensive emergency (high BP + signs of organ damage)

This requires immediate emergency care because high blood pressure is damaging vital organs (brain, heart, kidneys, etc.) right now.

2) Severe hypertension without acute organ damage (high BP, but no symptoms)

This still needs prompt medical attention, but it is often managed with urgent outpatient treatment rather than IV medications—depending on your situation.

Call 911 if you have high BP AND any of these symptoms

If your BP is around or above 180/120 and you have:

• chest pain or pressure
• shortness of breath
• severe headache with confusion
• weakness, numbness, or facial droop
• trouble speaking
• sudden vision changes
• severe back pain

…call 911.

Do not drive yourself if you feel unstable or neurologic symptoms are present.

What to do if you see a very high number but you feel okay

If you get a reading above 180/120 and you have **no symptoms**, do this:

Step 1: sit and reset for 5 minutes

• feet flat, back supported
• arm supported at heart level
• no talking
• slow breathing

Step 2: recheck (two readings)

Take two readings, one minute apart.

Step 3: evaluate the trend

Ask yourself:

• Is this the first time I’ve seen a number this high?
• Did I measure right after coffee, nicotine, exercise, or stress?
• Is my cuff the right size?

Step 4: contact your clinician promptly

If your numbers remain severely elevated after proper recheck, call your clinician’s office, urgent line, or on-call service for guidance.

If you cannot reach anyone and readings remain extremely high, seek urgent medical evaluation.

What NOT to do

• Don’t take extra doses of blood pressure medication unless your clinician specifically instructed you to do so.
• Don’t try to “crash” your blood pressure quickly with home remedies.
• Don’t repeatedly recheck every minute for an hour—anxiety can drive readings higher.

Why symptoms matter

High BP can cause or reflect serious events like:

• stroke
• heart attack
• heart failure exacerbation
• aortic problems
• kidney injury

Symptoms help detect these situations. But remember: not everyone has obvious symptoms, which is why severe readings that persist deserve prompt attention.

Special situations

Pregnancy

High blood pressure in pregnancy can be dangerous. If you are pregnant and your readings are high, contact your obstetric clinician urgently.

Known kidney disease, heart disease, or prior stroke

If you have these conditions, be more cautious and contact your clinician sooner with severe readings.

After the crisis: how to prevent repeat scares

The best way to reduce “panic moments” is to:

• measure correctly at home
• track a 7-day average
• treat the average, not a single outlier
• follow a long-term plan (lifestyle + medication when indicated)

Quick decision guide (copy/paste)

• **BP > 180/120 + symptoms** → Call 911
• **BP > 180/120, no symptoms** → Sit 5 minutes, recheck twice, contact clinician promptly
• **BP 140–179/90–119** → Not usually an emergency, but needs medical follow-up and a plan
• **BP 130–139/80–89** → Stage 1: confirm with home readings; lifestyle first for many people