The parameters of a high blood pressure emergency


DEAR DR. ROACH: At what point is high blood pressure a medical emergency (i.e., needs to be treated TODAY, or at least before, say, going out of the country next week)?

I’ve never had an issue with high blood pressure — at a gynecology appointment last year it was fine, and at a general internist appointment the year prior it also was fine. In the past few days, though, I’ve had really high numbers: 140/81, 161/97, 167/109 and 171/98. I’m looking for a new internist (mine retired) and have a message in to one recommended by my gynecologist, but do I need to find someone (anyone) today? Or at least in the next few days? — C.P.

ANSWER: High blood pressure is an emergency when it is causing symptoms or ongoing damage to your organs. It is called “urgent” when the number is very, very high (usually greater than 180/120) but without symptoms or evidence of organ damage.

The organs most affected by high blood pressure are the eyes, brain, kidney and blood vessels/heart. The eye disease usually doesn’t have symptoms, but can cause bleeding in the retina, so a careful look in the eyes is part of the evaluation. Headache with nausea and vomiting suggests ongoing damage to the brain, and precedes seizures and coma, so it also must be taken very seriously.

Without any of these symptoms, and with blood pressure not at the critical level, you don’t need to see someone today. Within the next few days, though, it would be a very good idea to see someone in order to confirm that the blood pressure is that high. If so, the doctor will consider any diagnoses that would cause the blood pressure to go up quickly, as well as begin the process of bringing down the blood pressure judiciously, using medication as well as nonmedication options.

DEAR DR. ROACH: I am a 49-year-old female in good health who has had tonsil stones off and on since childhood. It took me a long time to figure out what was causing my awful and embarrassing bad breath. Can you please explain more about them and my options for ridding myself of them? I had thought that if I had my tonsils removed, it would take care of the problem. Is that a possible solution? — E.E.

ANSWER: Tonsil stones aren’t always hard stones the way kidney, salivary or gallstones are. They are thick, waxy material that collects in the deep recesses in the tonsils, called “crypts.” Over time, they can become mineralized and hard. They are indeed a source of bad breath, as they are associated with bacteria, which release unpleasant odors.

They can be removed, in many cases, by the individual, either using a soft cotton swab, back of a toothbrush or water irrigator. I make this suggestion with trepidation because tonsil tissue can bleed easily. Please be very careful if you choose to do this.

Tonsillectomy is a possible solution to bad breath that is due to tonsilloliths that cannot be managed by self-care. I have sent only a few of my own patients to tonsillectomy, and the recovery for this surgery as an adult is unpleasant, at best. Don’t go lightly into that surgery.