A hypertensive emergency caused by severe high blood pressure typically occurs when blood pressure readings are 180 over 120 or higher, report researchers at Merck. Usually damage is done to one or more organs and the patient exhibits a number of symptoms. While high blood pressure typically does not produce significant or noticeable signs and symptoms, long-standing or severe high blood pressure will be a recognizable condition.
Bleeding
People with a severe form of high blood pressure called malignant hypertension will experience bleeding in the eyes from swelling and pressure placed on the back of the eyes.
Headache
A headache is a common symptom of severe high blood pressure and tends to worsen as the condition goes untreated.
Vomiting
Nausea, accompanied by vomiting is common among those with severe hypertension.
Drowsiness
Sleepiness can occur during a high blood pressure attack, making the patient appear drowsy. Untreated, drowsiness caused by high blood pressure can lead to a coma.
Increased Heart Rate
Heart palpitations and in increased heart rate is a common sign of severe high blood pressure in those who are at risk for hypertension.
Other Signs
Tremors, paleness and excessive perspiration often are present during a severe high blood pressure attack.


