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Is 136/128 Blood Pressure Hypertensive Crisis?

136/128 blood pressure is rated at the ‘Hypertensive Crisis’ level by US standards and is classed as a ‘Hypertension Stage 3’ blood pressure reading by the EU, UK and Japan, also known as ‘Severe Hypertension’

What does 136/128 blood pressure mean?

What 136 over 128 blood pressure means:

A BP reading of 136 over 128 means your blood pressure is classed at the Hypertensive Crisis level, or Stage 3 (severe) depending which nation’s scale you look at; a systolic pressure (when the heart contracts on a beat) reading of 136 mmHg and a resting, diastolic pressure (when the heart is dilated or relaxing between beats) reading of 128 mmHg. Blood pressure readings are presented in millimetres of mercury, the units being mmHg (discover why here).

You may find it written as blood pressure 136 over 128, or more simply BP 136/128

Reads Systolic Diastolic
136-over-128 136 128

Looking at your systolic and diastolic numbers independently, means they would each fall into the following categories:
  • A systolic reading of 136 is generally considered to be at the ‘prehypertension’ level.
  • A diastolic reading of 128 is generally considered to be at the ‘severe hypertension’ level.

Between the two, the one falling into a less healthy range determines your blood pressure’s overall status. In your case, it is defined as severe hypertension, because your systolic reading is healthier when comparing it to the status of your diastolic reading.

You can see your blood pressure reading of 136 over 128 plotted on the chart above, noting that your overall classification for these BP readings falls into the severe hypertension range.

Minor variations exist in the naming conventions and specific boundaries of each category between different nations. We show what these differences are in the tables presented later in this article so you know where you stand on the EU, US, UK, Japan and International Society of Hypertension (ISH) scales and plot you on the United States’ blood pressure chart too. It is important to consider that a single blood pressure reading is not definitive and it can be affected by a number of factors.

If you regularly take your blood pressure readings at home with a blood pressure monitor (sphygmomanometer or blood pressure gauge), you will have a more consistent average to work from than if you only go to the doctor for the occasional single reading. This way, you can better understand if your blood pressure is okay in general or whether you need to make some changes to your lifestyle or consult with your doctor about whether hypertension medicine is required to get a lower blood pressure.

The column chart of your blood pressure is shown above and displays the status of your systolic reading (higher blood pressure number) of 136mmHg compared to your diastolic reading (lower blood pressure number) of 128mmHg. Using these two blood pressure figures, you can go on to establish what your blood pulse pressure is.

What Is Blood Pulse Pressure?

The difference in value between your systolic and diastolic readings, which are shown on the blood pressure chart above, is known as pulse pressure. Your pulse pressure is therefore 8mmHg, calculated by subtracting your diastolic reading of 128mmHg from the systolic reading of 136mmHg.

A normal pulse pressure is typically considered to be around 40mmHg. Your pulse pressure will vary naturally with different blood pressure readings but the variation will typically be in the 5 to 10 mmHg range. As always, it is best to take a number of different readings to determine a truly representative average.

A pulse pressure which is less than 25% of your systolic pressure is considered concerningly low and over 100%, would be considered wide. Your pulse pressure of 8mmHg as a percentage of your systolic reading of 136mmHg comes in at 6%.

Low or narrow pulse pressure typically indicates that the heart is not able to pump a large enough volume of blood through it when it beats as would be expected. This is quite often seen in people who might be experiencing issues such as heart valve disease or heart failure. It may also result from significant blood loss from an injury or major internal bleeding.

Wide pulse pressure on the other hand, which can also be referred to as high pulse pressure, can occur during exercise and is regularly seen in endurance athletes and high muscle-mass individuals without much concern. However, for less active and aging individuals that may be experiencing hardening of the arteries, a wide pulse pressure develops for different reasons and that can be a warning sign of increased risk of stroke, heart rhythm problems and heart disease.

If you are concerned about your pulse pressure, ask your healthcare professional for advice.

Different Countries May Interpret 136/128 Differently

Your 136/128 reading is seen as Hypertension Stage 3 in most countries, the specific boundaries for each category and the naming of them can vary slightly between nations such as stage/grade or at the upper levels, stage 3/severe/crisis etc.

Revisions to these scales also occur, notably in 2017, leading U.S. health groups, including the American College of Cardiology and the American Heart Association, set lower levels for what counts as the start of high blood pressure and removed the term prehypertension from their scale. Yet when the EU later reviewed their scale in 2018, they maintained a higher boundary for the start of hypertension. So, large segments of the US population defined as having high blood pressure would not be considered to be suffering from hypertension by the EU. The UK also used to consider a diastolic reading over 110 mmHg as severe but this boundary was later moved up to be greater than 120 mmHg.

Where Does My Blood Pressure Feature On The American College of Cardiology and American Heart Association (ACC-AHA) Hypertension Chart Scale?

The ACC/AHA hypertension scale was most recently revised in 2017 and the major change at that time was lowering the definition of the start of hypertension from ≥140/≥90 mmHg to ≥130/≥80 mmHg. It also re-classified “prehypertension” as “elevated” blood pressure (120-129/<80 mmHg).

Your blood pressure readings on the ACC/AHA scale are shown below:

On the chart above you can see your blood pressure reading, this time plotted on the ACC/AHA scale giving an overall BP classification of hypertensive crisis.

Seen above, the column chart compares your systolic (higher blood pressure number) reading of 136 to the diastolic (lower blood pressure number) reading of 128 and the status they have if considered one by one, but this time using the ACC/AHA hypertension scale which gives you a systolic status of hypertension stage 1 and a diastolic status of hypertensive crisis.

Categorisations of Blood Pressure by Region/Country

Here we present the latest revised blood pressure tables and naming terms used by the EU, US, Japan, UK and International Society of Hypertension (ISH). Some differentiate office vs home readings, office not meaning your workplace but the office of the medical staff. The reason this differentiation is made is because medical environments can be stressful and raise the readings compared to what is achieved when relaxing at home and taking your own measurements.

European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) Classifications

Since 2023: source
Category Systolic (mmHg) Diastolic (mmHg)
Optimal (Ideal) <120 and <80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥180 and/or ≥110
Isolated systolic hypertension ≥140 and <90
Isolated diastolic hypertension <140 and ≥90

American College of Cardiology (ACC)/American Heart Association (AHA) Classifications

Since 2017: source
Category Systolic (mmHg) Diastolic (mmHg)
Normal <120 and <80
Elevated 120-129 and <80
Stage 1 130-139 or 80-89
Stage 2 ≥140 or ≥90
Hypertensive crisis >180 and/or >120

Japanese Society of Hypertension (JSH) Classifications

Since 2019: source
Classification Office blood pressure (mmHg) Home blood pressure (mmHg)
SBP DBP SBP DBP
Normal blood pressure <120 and <80 <115 and <75
High normal blood pressure 120–129 and <80 115–124 and <75
Elevated blood pressure 130–139 and/or 80–89 125–134 and/or 75–84
Grade I hypertension 140–159 and/or 90–99 135–144 and/or 85–89
Grade II hypertension 160–179 and/or 100–109 145–159 and/or 90–99
Grade III hypertension ≥180 and/or ≥110 ≥160 and/or ≥100
(Isolated) systolic hypertension ≥140 and <90 ≥135 and <85

UK National Health Service (NHS)/British Heart Foundation(BHF) Classifications

Since 2023: source
Classification Office blood pressure (mmHg) Home blood pressure (mmHg)
SBP DBP SBP DBP
Low blood pressure <90 <60 <90 <60
Normal blood pressure (Under 80s) 90–120 60–80 90–120 60–80
Normal blood pressure (Over 80s) <150 <90 <145 <85
High-normal blood pressure (pre-hypertension) 120–140 80–90 120–140 80–90
Stage one 140–160 90–100 135–150 85–95
Stage two 160–180 100–120 >150 >95
Stage three (Severe hypertension) >180 >120 N/A N/A

International Society of Hypertension (ISH) Classification

Since 2020: source
Category Systolic (mm Hg) Diastolic (mm Hg)
Normal BP <130 and <85
High-normal BP 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension ≥160 and/or ≥100

What Is A Normal Blood Pressure Range?

Ideally your blood pressure should be between 90/60mmHG and 120/80mmHg to be considered within the normal blood pressure range, also known as the normotension range. The main concern however, often referred to as the “silent killer,” is high blood pressure or hypertension, which rarely has obvious symptoms. The World Health Organisation estimates 1.28 billion adults aged 30-79 have high blood pressure, with 46% of those unaware that they have it. If left untreated persistent hypertension can increase your risk of a number of serious and potentially life-threatening health conditions, such as:

    – aortic aneurysms
    – heart attacks
    – heart disease
    – heart failure
    – kidney disease
    – peripheral arterial disease
    – strokes
    – vascular dementia

If you have high blood pressure, reducing it even a small amount can help lower your risk of experiencing these potentially life threatening conditions.

Should I be concerned about my ‘severe hypertension’ or ‘hypertensive crisis’ blood pressure status?

Yes. Your blood pressure’s overall status comes in as being at the ‘severe hypertension’ level in general. On the ACC/AHA (American College of Cardiology/American Heart Association) scale it also rates at the similar ‘hypertensive crisis’ level. This is a very high blood pressure.

Your blood pressure is at a dangerously high level with increased risk of it resulting in a stroke and organ damage – medical attention should be sought immediately and your blood pressure readings confirmed. With blood pressures consistently around these levels, blood vessels become inflamed causing them damage, blood or fluid may be forced out from them impacting the efficiency with which the heart is able to pump blood around the body and can lead to potentially fatal consequences.

You may not notice any symptoms but those associated with severe hypertension/hypertensive crisis can include:

  • Severe headaches
  • Shortness of breath
  • Seizures
  • Dizziness
  • Nausea
  • Severe anxiety
  • Unresponsiveness
  • Chest pain
  • Blurry vision
  • Fluid on the lungs (pulmonary edema) or fluid build-up in tissues

Once blood pressure reaches these severe hypertension or hypertensive crisis levels you may or may not experience damage to your organs. If damage to your organs has or does occur then it becomes an emergency situation associated with life threatening complications. Treatments may include hospitalisation, intravenous and oral medications.

Causes of hypertensive emergency may include:

  • Heart Attack
  • Stroke
  • Heart failure
  • Kidney failure
  • Rupture of the aorta artery (aneurysm)
  • Incompatible medicine interactions
  • Not taking prescribed blood pressure medication
  • Heart failure
  • Pregnancy eclampsia (convulsions)

Even without any organ damage occurring there is still great urgency to reduce your blood pressure if it is coming in around these hypertensive crisis levels, so you should seek to have accurate measurements of your blood pressure confirmed by health professionals straight away. Lifestyle changes to lower blood pressure become less effective at these sorts of severe hypertension levels, particularly with the urgency required to reduce it, so blood pressure medication and or hospital treatment will most likely be required to quickly bring the blood pressure down to a safer level.

Key Takeaways:

  1. Blood Pressure Classification: A reading of 136/128 is classified as:
    • ‘Hypertensive Crisis’ by US standards.
    • ‘Hypertension Stage 3’ or ‘Severe Hypertension’ by the EU, UK, and Japan.
  2. Understanding the Reading:
    • Systolic Pressure (when the heart contracts): 136 mmHg
    • Diastolic Pressure (when the heart relaxes): 128 mmHg
  3. Variations in Classification: Different countries and organizations have their own scales and definitions for hypertension. It is essential to be aware of these differences and understand where your blood pressure stands on various scales as they are modified over time.
  4. Blood Pulse Pressure:
    • Pulse pressure is the difference between systolic and diastolic readings. For a reading of 136/128, the pulse pressure is 8mmHg. A typical pulse pressure is around 40mmHg.
    • Your pulse pressure of 8mmHg as a percentage of your systolic reading of 136mmHg is 6%.
    • A pulse pressure less than 25% of the systolic pressure is considered concerningly low, and over 100% would be considered wide.
  5. Immediate Medical Attention Needed:
    • A blood pressure reading at this level indicates a critical risk. It is urgent to consult with a medical professional today if you are not already being treated for high blood pressure. Persistent readings at this level can lead to strokes, organ damage, and other life-threatening conditions.
    • Symptoms associated with severe hypertension/hypertensive crisis can include severe headaches, shortness of breath, seizures, dizziness, nausea, severe anxiety, chest pain, blurry vision, and fluid on the lungs. If you are experiencing symptoms like these alongside severe BP readings, seek emergency medical attention right away.

As the ISH says, hypertension “is the leading cause of death worldwide, affecting more than 1.4 billion people and accounting for more than 28,000 deaths each day.”

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