Blood pressure measures the force of blood against the artery walls as the heart pumps. The reading consists of two numbers: systolic pressure (top number), which measures pressure during a heartbeat, and diastolic pressure (bottom number), which measures pressure when the heart rests between beats. Readings fluctuate throughout the day based on activity, stress, and medication, but consistently high measurements require careful evaluation. A reading of 168/118 millimeters of mercury (mm Hg) represents a severely elevated state that demands immediate medical attention to prevent serious health complications.
Understanding the Classification of 168/118
A blood pressure reading of 168/118 mm Hg falls into the category of Stage 2 Hypertension, the most severe classification before a medical crisis. Stage 2 Hypertension is defined by a systolic pressure of 140 mm Hg or higher, or a diastolic pressure of 90 mm Hg or higher. Both the systolic reading (168 mm Hg) and the diastolic reading (118 mm Hg) significantly exceed these thresholds.
A Hypertensive Crisis begins when blood pressure reaches 180 mm Hg systolic and/or 120 mm Hg diastolic. Although 168/118 is slightly below the 180/120 threshold, the diastolic number of 118 mm Hg is very close to the crisis level. This proximity indicates an imminent risk of severe organ damage if the pressure is not lowered promptly. A sustained reading at this level strains the heart, brain, kidneys, and eyes, increasing the likelihood of an adverse cardiovascular event.
Immediate Action and When to Seek Emergency Care
The action required for a reading of 168/118 depends entirely on whether acute symptoms are present. If this measurement is obtained at home, sit quietly for five minutes, relax, and re-check the pressure to ensure accuracy. If the second reading remains high, contact a healthcare provider immediately, even if you feel fine.
The presence or absence of symptoms determines if the situation is a Hypertensive Urgency or a Hypertensive Emergency. A Hypertensive Emergency involves severe high blood pressure accompanied by signs of acute organ damage. Symptoms indicating an emergency include severe headache, blurred vision changes, chest pain, shortness of breath, numbness or weakness, or difficulty speaking. If any of these accompany the 168/118 reading, call emergency services immediately, as this signifies life-threatening damage to organs.
If the severe blood pressure elevation occurs without symptoms of acute organ damage, it is classified as a Hypertensive Urgency. An urgency requires prompt medical evaluation, often within a few hours, to safely reduce the pressure and prevent progression to organ damage. Do not attempt to self-treat by taking extra doses of medication without explicit instruction from a doctor, as an overly rapid drop in pressure can also be dangerous.
Underlying Causes of Severe Blood Pressure Elevation
Most cases of high blood pressure fall under Primary (or Essential) Hypertension, accounting for about 90 to 95 percent of adult diagnoses. This type develops gradually over many years due to genetic factors, age, and lifestyle choices, such as a diet high in sodium, physical inactivity, and excessive alcohol consumption. The gradual narrowing and hardening of the arteries over time contribute to this rising pressure.
In a smaller number of cases, the severe elevation is due to Secondary Hypertension, caused by an identifiable underlying medical condition. This type tends to appear more suddenly and can result in higher readings than primary hypertension. Common causes include kidney disease, which impairs the body’s ability to regulate fluid and salt balance, and obstructive sleep apnea.
Other causes involve endocrine disorders, such as hyperaldosteronism, Cushing syndrome, or thyroid issues, which disrupt hormone levels regulating blood vessel function. Certain medications, including some over-the-counter decongestants, birth control pills, and specific pain relievers, can also elevate blood pressure. Identifying and treating the root cause of secondary hypertension often leads to a significant reduction or resolution of the high blood pressure.
Strategies for Long-Term Blood Pressure Control
Controlling a severe reading like 168/118 requires a comprehensive, long-term strategy involving medication and significant lifestyle modifications overseen by a physician. Medical management typically uses anti-hypertensive drugs from various classes, such as ACE inhibitors, calcium channel blockers, or diuretics, often in combination to achieve optimal pressure reduction. Consistent adherence to the prescribed medication regimen is necessary for stabilizing the arteries and preventing future spikes.
Dietary changes are necessary, often centered around the Dietary Approaches to Stop Hypertension (DASH) eating plan. This approach emphasizes consumption of fruits, vegetables, whole grains, and low-fat dairy, which are rich in blood pressure-lowering minerals like potassium, calcium, and magnesium. The DASH plan also limits foods high in saturated fats, added sugars, and sodium.
Reducing sodium intake is an effective lifestyle change for hypertension control. The standard recommendation is to limit daily sodium consumption to no more than 2,300 milligrams, though aiming for 1,500 milligrams per day often provides greater benefit. Regular physical activity, such as at least 30 minutes of moderate exercise five days a week, complements these efforts by improving cardiovascular health and managing weight.