Treating high blood pressure: An overview
| January 1, 2007
In-Depth Report
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 (see Table 3).
Guidelines released in May 2003 by the JNC, which are summarized here, offer formal guidance on who should be treated and what sort of treatment may be best. The guidelines emphasize the importance of tackling escalating blood pressure earlier rather than later, thereby heading off heart disease, stroke, and kidney damage.
But there's a simpler way to understand blood pressure control: Generally speaking, the lower the better. The consensus among hypertension specialists is that people should do whatever it takes to get their blood pressure numbers down to the healthy range. Whatever works for you is the right strategy to adopt, but it most likely will involve some combination of diet, exercise, stress reduction, and medication.
This report will discuss lifestyle modifications and antihypertensive medications in greater detail on the following pages. First, though, this section provides an overview of recommendations for what to do, depending on which blood pressure category you fall into.
Table 3: Quick guide to hypertension treatment |
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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 drug. Many people start with one medication, but may need to go to a second or third to find a treatment that works. If you have other health conditions, you may need a different drug or an additional one. |
Stage 2 hypertension |
160 or higher |
100 or higher |
Change your health habits. It's likely that you'll need to take at least two blood pressure medications. |
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. |
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If your reading is normal
If 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").
Prehypertension
You have prehypertension if 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
You have stage 1 hypertension if your systolic blood pressure is between 140 and159 or your diastolic pressure is between 90 and 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, but many people find that they need to take some type of medication in order to reduce their blood pressure numbers to healthy levels. You may have to try several drugs to find a combination that works best.
The initial choice of drug may depend on whether you have other health problems — such as diabetes, migraine headaches, or cardiac arrhythmias — in addition to hypertension. 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.
Stage 2 hypertension
You have stage 2 hypertension if 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 at least two medications. 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 additional drugs to the mix.
Review Date: 2007-01-01
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