Hypertension Stages and Types

“If you find yourself in this situation, please do not panic,” Galper says. “First, sit quietly for five minutes and retake your blood pressure. If it’s still elevated, contact your health care provider immediately. Depending on the situation, you may be advised to go to urgent care or schedule a same-day appointment.” 

The AHA advises calling 911 if your blood pressure is higher than 180/120 and you are having symptoms of damage to a vital organ, including chest pain, shortness of breath, back pain, numbness/weakness, changes in vision or difficulty speaking. This could signal that you are in a hypertensive emergency, also referred to as hypertensive crisis. Severe headaches have also been attributed to hypertensive emergency. 

Uncontrolled hypertension without symptoms of organ damage should be managed in an outpatient setting by a primary care provider using slow/long-acting medications that often take a couple of weeks to reach full effect, Cohen says. “We don’t want to correct high blood pressures too quickly in this scenario, as rapid reversal … can cause more harm than good by causing a rapid decrease in blood flow to organs that are used to having high blood flow.” 

Malignant hypertension 

A condition commonly called malignant hypertension is a high blood pressure, typically 180/120, that is causing damage to multiple vital organs and is considered an emergency condition. Thanks to blood pressure medications and prevention efforts, it is rarely seen today.

“Malignant hypertension is the physiological result of a hypertensive emergency — it’s essentially the bad things happening in the body that are causing acute target organ damage,” says Cohen.

Other forms of hypertension 

Pulmonary hypertension 

Pulmonary hypertension affects arteries in your lungs and on the right side of your heart. It is usually seen in people who have underlying medical conditions, such as heart or lung disease. In a form of this condition called pulmonary arterial hypertension (PAH), blood vessels in your lungs are damaged, which slows how blood flows through your lungs. Therefore, the blood pressure in your lung arteries rises because the heart is working harder to pump the blood through. Over time, this can lead to a weakening of the heart muscle. This condition is usually diagnosed in people between the ages of 30 and 60, according to the Mayo Clinic. 

What is primary versus secondary hypertension? 

Primary hypertension

Primary hypertension is the more common form of high blood pressure and was previously known as essential hypertension. While a definitive cause isn’t known, your age, genetics, what you eat and having a sedentary lifestyle can be risk factors. Additionally, smoking, excess drinking and salt intake, stress, and being overweight or obese are thought to contribute.

Secondary hypertension

Secondary hypertension refers to high blood pressure that has a direct identifiable cause that can potentially be reversed. This type of hypertension only occurs in 5 to 10 percent of high blood pressure cases. 

Underlying causes can include adrenal gland disease; side effects of medications like birth control pills, stimulants and antidepressants; and thyroid abnormalities.

Resistant hypertension 

Resistant hypertension is blood pressure that stays over 140/90 even when the patient is taking three or more prescribed blood pressure medications. This may be the diagnosis if hypertension is still present after six months of treatment. Approximately 12 percent of adults who have high blood pressure fall into the resistant hypertension grouping, according to the Cleveland Clinic.

As with other types of hypertension, being overweight or obese, being physically inactive, consuming foods high in salt, and heavy alcohol use are all risk factors for resistant hypertension. Painkillers, particularly NSAIDs like ibuprofen, and nasal decongestants can also contribute to resistant hypertension. 

Can blood pressure get too low?

While older people often tolerate a lower blood pressure well, for people over 50, consistently low blood pressure — below 90/60 — can be concerning. It may lead to dizziness, fainting and an increased risk of falls.

“We need to carefully balance your blood pressure management to avoid these risks,” Galper says. “For my patients who experience any symptoms like lightheadedness or frequent falls, I can adjust their treatment plan accordingly.” 

Orthostatic hypotension

Orthostatic hypotension, also called postural hypotension, is a condition that occurs when there is a sudden drop in blood pressure as a person stands up after sitting or lying down. It can cause dizziness or fainting. Generally, orthostatic hypotension is mild, but it’s important to talk with your health care provider if you regularly feel lightheaded when standing up. Dehydration or lengthy bouts of bed rest can contribute as well, as can medications, including calcium channel blockers, that are used to treat high blood pressure.

With this guide we delve deeper into the specific stages and types of hypertension and how they can impact your health.

High Blood Pressure: Symptoms, Causes and Tests 

Hypertension increases with age, and nearly three-quarters of people over age 60 have high blood pressure. Explore the science behind risk factors for high blood pressure, the tools your doctor may use to diagnose the condition, and why the disease is often called a “silent killer.”

Read more on high blood pressure symptoms, causes and tests.

High Systolic Blood Pressure

The top number in a blood pressure reading, called systolic blood pressure, measures the pressure in your arteries when your heart beats. For most hypertension, both the top and bottom numbers (the diastolic) are high — 130/80 or above. But an estimated 15 percent of people over age 60 have isolated systolic hypertension, where the pressure in their arteries is 130 or above when the heart beats but their diastolic pressure, which is measured when the heart is relaxed, is below 80. 

Read more about high systolic blood pressure. 

High Diastolic Blood Pressure 

The bottom number in a blood pressure reading, known as the diastolic, measures the pressure in your arteries when the blood is flowing back to the heart through the veins. In rare cases, diastolic blood pressure will be high while the systolic is not. This is called isolated diastolic hypertension.

Read more about high diastolic blood pressure.

White Coat Hypertension 

“White coat hypertension,” also known as “white coat syndrome,” is a condition where a patient’s blood pressure spikes in medical settings due to anxiety. It’s not uncommon, and while it might seem harmless, it can indicate that their blood pressure might also rise in other stressful situations. Patients who experience white coat syndrome should monitor their blood pressure at home using a validated device and keep a record of their readings. This data will help their doctor determine if they need treatment outside of the clinical environment. 

“Many patients at Kaiser Permanente use remote monitoring tools that report changes in their blood pressure to their health care team daily,” Galper says. “This allows doctors to recommend changes to medication or schedule a video visit to help a patient make other changes without taking time off from work or making a trip to the doctor’s office.”

Read more about white coat hypertension.