Blood pressure is a measurement of the force exerted by circulating blood against the walls of the body’s arteries. This measurement is given as two numbers: the systolic pressure (the top number, measuring pressure when the heart beats) and the diastolic pressure (the bottom number, measuring pressure when the heart rests between beats). A reading of 198 millimeters of mercury (mmHg) in the systolic position represents an extremely elevated force, placing it well above the threshold considered healthy. Such a reading requires immediate and serious attention to prevent severe health consequences.
Understanding the Severity of 198 mmHg
A blood pressure reading where the systolic number is 180 mmHg or higher, or the diastolic number is 120 mmHg or higher, is medically categorized as a hypertensive crisis. A reading of 198 mmHg systolic falls significantly into this severe range, regardless of the diastolic number. This level of elevation indicates that the force on the arterial walls is high enough to potentially cause acute damage to vital organs.
The classification of this crisis depends on whether acute organ damage is present. A hypertensive urgency is diagnosed when the blood pressure is severely elevated, such as 198 mmHg, but there are no signs or symptoms of acute damage to the brain, heart, kidneys, or eyes. This situation still necessitates prompt medical intervention, usually within a few hours.
In contrast, a hypertensive emergency occurs when blood pressure is at this severe level and is accompanied by evidence of acute, life-threatening organ damage. Damage can include complications like stroke, acute heart failure, or kidney failure. For a reading of 198 mmHg, the difference between urgency and emergency hinges entirely on the patient’s symptoms and clinical assessment.
Immediate Action Steps and Warning Signs
The immediate response to a 198 mmHg reading depends on the presence of specific acute symptoms. If you measure your blood pressure and the reading is 198 mmHg, you should wait a few minutes and then check it again to confirm the reading. If the second measurement remains at this severely elevated level, you must check for any warning signs of acute organ damage.
Warning signs that indicate a hypertensive emergency include sudden, severe headaches, chest pain, or shortness of breath. Other serious symptoms are blurred vision, difficulty speaking, numbness or weakness, especially on one side of the body, or general confusion. If any of these symptoms accompany the 198 mmHg reading, you must call emergency services immediately, as this signals a life-threatening situation.
If the reading is 198 mmHg and you have no acute symptoms, this is classified as a hypertensive urgency. You should contact a healthcare provider immediately or visit an urgent care facility the same day for evaluation. It is important not to self-medicate or wait for the pressure to drop naturally. The goal is to gradually reduce the pressure over a period of hours or days to prevent complications, as rapidly lowering blood pressure when symptoms are absent can be harmful.
Underlying Causes and Contributing Factors
A sudden spike in systolic blood pressure to 198 mmHg is often triggered by a combination of chronic underlying conditions and acute factors. The most frequent cause for a dramatic spike in people already diagnosed with high blood pressure is non-adherence to prescribed medication regimens. Missing doses or abruptly stopping certain blood pressure medications can lead to a dangerous rebound effect.
Underlying health issues also play a significant role in causing blood pressure to reach such extreme levels. Conditions like chronic kidney disease impair the body’s fluid and blood pressure regulation. Hormonal imbalances from thyroid issues or an overactive adrenal gland, which produces hormones that regulate water and sodium, can also cause severe elevations.
Acute, non-disease-related factors can also push a high-risk individual into the crisis zone. High levels of acute stress or anxiety can cause temporary, dramatic blood pressure spikes. Certain over-the-counter medications, particularly cold and flu remedies containing decongestants, or nonsteroidal anti-inflammatory drugs (NSAIDs), may dangerously increase blood pressure. The use of stimulants, such as high-dose caffeine or illicit drugs like cocaine, also presents a risk for severe hypertensive episodes.
Preventing Future Episodes and Long-Term Control
Following an episode of severely elevated blood pressure, establishing a robust long-term management strategy is necessary to prevent recurrence. This begins with a thorough re-evaluation of your medication regimen by a healthcare provider. Strict adherence to the prescribed blood pressure medication schedule is the best defense against future spikes, and any adjustments must be done under medical guidance.
Consistent lifestyle modifications are equally important for sustained blood pressure control. Adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan, which emphasizes fruits, vegetables, whole grains, and lean proteins, can significantly help lower pressure. Reducing sodium intake to recommended levels is a particularly effective step in managing hypertension.
Regular home blood pressure monitoring provides immediate feedback and allows for early detection of concerning trends before they reach the crisis level. Tracking and reporting these readings to a physician allows for timely medication adjustments. Follow-up appointments should also include screening for underlying causes, such as kidney function tests, to ensure all contributing health issues are being managed effectively.