By Dr. Diane Gorgas

Hypertension, or high blood pressure, is called the "silent killer."

But during a recent morning in the emergency department, it seemed anything but silent.

Medics called to say they were en route with a 50-year-old man who was confused, had trouble breathing and complained of chest pain.

His vital signs were a heart rate of 100 (a little fast), a breathing rate of 24 per minute (more than a little fast) and blood pressure of 250/150 (OK, that got my attention.)

When he was rolled through the acute care room doors, he was moaning some, did not answer questions and barely flinched as the nurse placed an IV.

He coughed frequently. His blood pressure was no better, despite the nitroglycerin that the medics had started, and his oxygen level was critically low and getting worse.

My team recognized the need to start medications to bring his blood pressure down.

Within 20 minutes, a breathing tube was in place and he was sedated and receiving IV medications for his blood pressure. The result was beautiful -- 160/90. We were into the "non-emergency" range, and he started to wake up nicely.

As I left the patient, I thought about the others who awaited my attention. The next three patients I saw were:

• A 22-year-old woman who was 19 weeks pregnant and who had a history of hypertension. Her blood pressure was high, and she was suffering with cramps. I needed to find out if her pregnancy was in danger from her blood pressure causing decreased blood flow to her placenta.

• A 65-year-old man with congestive heart failure. A lifetime of poorly controlled hypertension led to a weak heart muscle that pumped blood ineffectively.

• A 36-year-old woman awaiting a kidney transplant. Her kidneys had failed because of high blood pressure. That day, she was sick after dialysis treatment.

Although labeled the "silent killer," high blood pressure has effects that seem anything but silent in my world.

Dr. Diane Gorgas is an emergency physician at Ohio State University Medical Center.