Blood Pressure: 228/123

Manometer, stethoscope



What a blood pressure reading of 228/123 means

Readings above 180 systolic pressure (the upper number) or above 110 diastolic pressure (the lower number usually indicate a hypertensive crisis -- putting you in the highest risk category for heart attack, stroke, and other acute life-threatening problems -- and requiring emergency care.

Very high blood pressure can cause symptoms such as headache, nausea and vomiting, mental confusion, vision changes, chest pain, or shortness of breath. If you notice any of these symptoms along with a blood pressure above 185/110, your high blood pressure is considered a hypertensive emergency; call 911.

During a hypertensive emergency, a medical team will work to bring your blood pressure down quickly. If you don't have these symptoms but your blood pressure remains high, doctors call this "hypertensive urgency." It's important to seek medical attention for hypertensive urgency, so that doctors can help bring your blood pressure down over a period of hours to days.

Often people don't notice any symptoms, even when blood pressure is very high. Over time, however, uncontrolled high blood pressure leads to chronic damage of the body's arteries and organs. Common results of this damage include enlargement of the heart, which can cause heart failure, and chronic kidney damage, which can eventually require dialysis.

What to do if your blood pressure reading is 228/123

  • Don't make a decision based on one BP reading alone.

  • Lie down and rest for several minutes before getting additional readings when you feel calm.

  • Watch for symptoms of hypertensive emergency, such as headache, nausea or vomiting, confusion, vision changes, chest pain and/or shortness of breath. These could be signs of a life-threatening problem and require a call to 911.

  • Be sure you're taking all medications as prescribed.

  • If several readings are above 210/130 but you don't have acute symptoms, call the doctor and ask if you should be seen immediately.

  • If a doctor isn't available, go to the emergency room to be assessed for hypertensive urgency.

  • Talk with a doctor about adjusting dosage of medications to bring your BP readings down.

  • Ask the doctor to check for other conditions that can worsen high blood pressure, such as sleep apnea.

  • Ask your pharmacist or doctor if you're on any medications that can worsen high blood pressure (these can include NSAIDs as well as some antidepressants).

  • If you haven't yet done so, purchase a home blood pressure monitor that uses an arm cuff and check your BP every few days. (Wrist and finger monitoring systems don't give accurate results.) Write down each reading, indicating the date and time, and bring this record to the doctor when you visit.

  • Once you've discussed your medical plan with your doctor, continue to pursue lifestyle modifications:

    • Stop smoking.

    • Lose weight or maintain healthy weight.

    • Increase physical activity.

    • Lower salt intake to less than 2g per day (most Americans get 5 to 10 grams a day).

    • Limit caffeine.

    • Limit alcohol.

    • Reduce stress.


Very high blood pressure in this range should almost always be treated, even in very old and frail adults. However, as people get older, they often become more sensitive to quick drops in blood pressure. For this reason, if there are no symptoms of hypertensive emergency, the plan for bringing down blood pressure tends to be more gradual in these older adults.

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Leslie Kernisan, MD Senior Medical Editor



What Does My Blood Pressure Reading Mean? Readings Near 228/123: