The difference between hypertensive emergency and hypertensive encephalopathy.

Written by Li Qiang
Intensive Care Unit
Updated on May 12, 2025
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The so-called hypertensive emergency is a condition where blood pressure rises very quickly, reaching a very high level in a short period of time. At this time, it does not necessarily lead to hypertensive encephalopathy, which is a more dangerous condition. Hypertensive encephalopathy indicates that due to the rapid rise in blood pressure, the pressure in the brain's blood vessels becomes excessively high. This pressure causes cerebral edema. At this point, because the blood pressure is higher than the brain's perfusion pressure, the brain becomes swollen, which is extremely dangerous. If the swelling is severe, it may lead to brain herniation, which can be fatal. Therefore, relatively speaking, hypertensive encephalopathy is much more serious than a hypertensive emergency and represents a dangerous stage of progression within a hypertensive crisis. Thus, hypertensive encephalopathy is a very dangerous condition and is one of the most critical manifestations within a hypertensive emergency.

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Which is more dangerous, low blood pressure or high blood pressure?

Blood pressure is a crucial indicator for maintaining human life. Both low blood pressure and high blood pressure can pose significant risks to the body. High blood pressure can lead to arteriosclerosis, and prolonged high blood pressure can cause cardiovascular and cerebrovascular diseases, with severe cases leading to cerebral ischemia and myocardial infarction. Low blood pressure affects the blood supply to vital organs and also brings negative factors to the body. Extremely low blood pressure can also endanger human life. Therefore, whether it is low blood pressure or high blood pressure, it should be correctly treated and improved under the guidance of a doctor to ensure the health of the body.

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Symptoms of Hypertension in Pregnant Women

During pregnancy, if a pregnant woman develops high blood pressure, initially there are no symptoms, because at the beginning the blood pressure just slightly exceeds 140/90mmHg. If the high blood pressure is only temporary, it generally does not affect the woman's body and therefore, she may not experience any symptoms. As the condition progresses, the symptoms of high blood pressure can cause physical harm to the woman, likely damaging the kidneys and causing proteinuria. The loss of protein can lead to edema in women, and as a result, many women's initial symptoms will appear as generalized swelling, which does not improve with rest. By measuring blood pressure and urinary protein, symptoms of hypertension in pregnant women can be detected. In the later stages of the disease, hypertension may sometimes be accompanied by dizziness, indigestion, and mild pain in the lower abdomen, which are all symptoms of hypertension in pregnant women.

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Difference between hypertensive encephalopathy and malignant hypertension

The difference between hypertensive encephalopathy and malignant hypertension can be discerned from their names, indicating they are different conditions. Hypertensive encephalopathy refers to a condition where blood pressure rises sharply in a short period, with diastolic pressure exceeding 120 mmHg and systolic pressure exceeding 200 mmHg. This dramatic increase in blood pressure causes cerebral vasospasm and increased cerebral perfusion pressure, leading to various manifestations of cerebral edema, primarily severe headache, nausea, vomiting, seizures, and even brain herniation. The emphasis is on the rapid rise in blood pressure over a short term and its impact on the brain, specifically cerebral edema. Malignant hypertension also involves a rapid increase in blood pressure to extremely high levels over a short period. However, the focus of malignant hypertension is on the impact on multiple organs throughout the body, including the brain, but also severely affecting the heart, potentially causing acute left heart failure and pulmonary edema. In the kidneys, it can lead to acute renal failure, characterized by reduced urine output or anuria. Thus, malignant hypertension emphasizes the effects on multiple vital organs, whereas hypertensive encephalopathy focuses primarily on the impact on the brain and central nervous system. Hence, there are some distinctions between the two conditions.

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Hypertensive crisis blood pressure values

At any stage of hypertension development and other disease emergencies, severe life-threatening blood pressure increases can occur, requiring emergency treatment. Hypertensive crises include hypertensive emergencies and hypertensive urgencies. Hypertensive emergencies refer to severe blood pressure increases within a short time—hours or days—with diastolic pressure greater than 130 mmHg and/or systolic pressure greater than 180 mmHg, accompanied by severe dysfunction or irreversible damage to critical organs and tissues such as the heart, brain, kidneys, retina, and major arteries. Hypertensive urgencies may present as increased blood pressure but without obvious target organ damage.

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How to Read a Blood Pressure Monitor for High Blood Pressure

As living standards improve, a blood pressure monitor has become an essential medical device in households. Electronic blood pressure monitors are very convenient for measuring blood pressure, especially for patients with hypertension. They allow patients to measure their blood pressure timely and adjust medication dosages accordingly. How to read a blood pressure monitor varies with different models. Typically, on an electronic blood pressure monitor, the first line displays the systolic pressure, also known as high blood pressure; the second line displays the diastolic pressure, also known as low blood pressure; and the third line displays the heart rate. These readings can help you know your systolic and diastolic pressures.