Is a blood pressure of 190/128 of immediate concern in someone on antihpertensives?

Yes!: Systolic BP (the upper number) should be less than 130 mmhg while on medications. Uncontrolled hypertension can lead to strokes, heart attacks and other bad problems. If you are on 3 or more meds for your bp, you may be a candidate for renal artery denervation. Get a home BP monitor and check your BP twice a day at random times, take this log to your doctor to get your BP down!

Stroke Potential: This is so high that you could have a stroke. It is an emergency whether you are on blood pressure medications or not.