Treating High Blood Pressure: An Overview

When you first look at them, your blood pressure readings may seem nothing more than a jumble of numbers. Yet your readings do more than indicate whether you have hypertension. They also help determine the course of action you and your doctor should take. Guidelines released by the JNC, which are summarized here, offer guidance on who should be treated and what sort of treatment may be best. The committee’s guidelines, issued in May 2003, emphasize the importance of tackling escalating blood pressure earlier rather than later, thereby heading off heart disease, stroke, and kidney damage.

This report will discuss lifestyle modifications and antihypertensive medications in greater detail on the following pages. First, though, this section provides an overview of the JNC’s recommendations for the various blood pressure categories.

If your reading is normal

Your blood pressure is below 120/80 mm Hg. This is where you want it to stay. If you are already committed to a healthy lifestyle, keep it up. If you’ve managed to keep within the normal range without much thought about your health habits, you might want to think again. Data from the Framingham Heart Study suggest that even if your blood pressure is normal at age 55, you run a 90% risk of developing hypertension within your lifetime. But a combination of exercise, weight loss, limited salt intake, a diet rich in fruits and vegetables, and limits on alcohol consumption can prevent hypertension (see “Adopting healthier habits”).

Table 2: Quick guide to hypertension treatment
Category	Systolic blood pressure (top number)	Diastolic blood pressure (bottom number)	What you should do
Normal	Less than 120	Less than 80	Stick with a healthy lifestyle including following a diet rich in fruits and vegetables and low in salt, using alcohol moderately, and maintaining a healthy weight.
Prehypertension	120-139	80-89	Change health habits. If you’re heavy, lose weight. Reduce salt in your diet. Eat more fruits and vegetables and get more exercise. Drink alcohol only in moderation. You do not need medication at this stage if you don’t have other health conditions. If you have diabetes or kidney disease, begin drug therapy if your blood pressure is above 130/80.
Stage 1 hypertension	140-159	90-99	Change your health habits and take a blood pressure medication. Many people start with a thiazide diuretic. If you have other health conditions, you may need a different medication or a second blood pressure drug.
Stage 2 hypertension	160 or higher	100 or higher	Change your health habits. It’s likely that you’ll need to take two blood pressure medications, usually a thiazide diuretic and something else.
Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension.

Prehypertension

Your systolic blood pressure reading is between 120–139, your diastolic pressure is between 80–89, or both. The risk of cardiovascular disease begins climbing at pressures as low as 115/75 mm Hg, and it doubles for every 20-point increase in systolic pressure and each 10-point increase in diastolic pressure. If your blood pressure falls into the prehypertension category and you do not have any other risk factors, lifestyle changes are the recommended treatment at this stage. If you have diabetes or chronic kidney disease, you should begin using antihypertensive medications beginning at pressures of 130/80 mm Hg.

Stage 1 hypertension

Your systolic blood pressure is between 140–159 or your diastolic pressure is between 90–99, or both. If you don’t have any accompanying conditions such as heart disease, diabetes, kidney disease, or a history of stroke you will usually start with lifestyle modifications and a single medication. Your doctor may let you try lifestyle modifications alone for two or three months to see if you may be able to avoid medication altogether.

While many people start out with a diuretic, those who suffer from additional risk factors may take a different type of medication (such as an ACE inhibitor, calcium-channel blocker, or beta blocker) or start off with one of these other drugs in combination with the diuretic. The JNC guidelines also recommend that African Americans, who are at a higher-than-average risk for hypertension-related complications, start with a two-drug regimen if blood pressure readings top 145/90 mm Hg.

Feet on scale

Vegetables on a fork

Woman jogging

Glass of wine

No matter what your blood pressure is currently, it’s important to engage in healthy habits, including watching your weight, eating a diet rich in fruits and vegetables, exercising regularly, and drinking alcohol in moderation.

Stage 2 hypertension

Your systolic pressure is at least 160 mm Hg, your diastolic pressure is at least 100 mm Hg, or both. In addition to lifestyle modifications, you will probably need to take two medications, usually a diuretic and another antihypertensive medication such as an ACE inhibitor, calcium-channel blocker, or beta blocker. If this course of action fails to bring your blood pressure down to your target level (below 140/90 for most individuals and below 130/80 for those with diabetes or chronic kidney disease), your doctor may add a third drug to the mix.