High Blood Pressure Calls
Handle high-BP calls safely — distinguish urgency from emergency and avoid over- and under-reacting.
Learning Objectives
- 1.Differentiate asymptomatic high BP from a hypertensive emergency.
- 2.Coach correct home BP technique.
- 3.Route high-BP calls appropriately.
Purpose
High home readings are common and usually not emergencies — but a high BP WITH symptoms can be. The skill is telling them apart and not overreacting to a single number.
What to ask
- •The actual reading, and how it was taken (rested? correct cuff?).
- •Symptoms NOW: chest pain, shortness of breath, severe headache, vision changes, weakness/slurred speech, confusion?
- •Took their BP meds today? Any recently stopped?
- •What do home readings usually run?
Emergency vs. elevated
- •Hypertensive EMERGENCY: very high BP (often ≥180/120) WITH symptoms of organ damage (chest pain, dyspnea, neuro changes, severe headache) → 911/ED.
- •Asymptomatic high reading: recheck with proper technique after resting; route to provider — not an ED trip by itself.
Escalate
High BP + chest pain, shortness of breath, neuro symptoms, or severe headache → 911/ED now. A high number alone, feeling well, is rechecked and routed.
What to send the provider
- •Reading(s) and technique, symptoms (or none), med adherence, home BP trend, your recheck values, urgency read.
Patient education script
- •"Sit and rest 5 minutes, then recheck with the cuff on a bare arm at heart level."
- •"If you ever have chest pain, trouble breathing, weakness, or a severe headache with high pressure, call 911."
Spanish phrase
Do you have chest pain, trouble breathing, or a severe headache right now?
¿Tiene dolor de pecho, dificultad para respirar, o un dolor de cabeza fuerte ahora?
TYEH-neh doh-LOR deh PEH-cho, dee-fee-kool-TAD PAH-rah res-pee-RAR, oh oon doh-LOR deh kah-BEH-sah FWER-teh ah-OH-rah
Mini case
A patient reports a home BP of 192/110 and a sudden severe headache with blurred vision.
What now?
Show answer
Very high BP WITH neuro symptoms (severe headache, vision changes) = hypertensive emergency. Direct to 911/ED now and notify the provider. This is not a recheck-and-route situation.
Checklist
- Got the actual reading and technique.
- Screened for organ-damage symptoms.
- Distinguished emergency from asymptomatic elevation.
- Coached recheck technique; routed appropriately.