Last Updated on April 27, 2025
Hypertension, commonly known as high blood pressure, is a significant health condition affecting millions worldwide. It is not a sudden event but rather a gradual progression through different stages, each with distinct risks and treatment strategies. Understanding these stages of hypertension is crucial for early detection and effective management.
What is Blood Pressure?
Blood pressure is the force exerted by circulating blood on the walls of blood vessels. It is measured using two numbers:
- Systolic pressure (top number): The pressure that blood exerts on the walls of vessels when the heart beats
- Diastolic pressure (bottom number): pressure when the heart rests between beats
A normal blood pressure reading is typically around 120/80 mmHg. If this reading is increased, multiple readings across the days are taken so that a diagnosis can be established.
The Stages of Hypertension
The American Heart Association (AHA) and the American College of Cardiology (ACC) have classified blood pressure into specific categories to guide diagnosis and treatment [1].
Normal Blood Pressure
- Systolic blood pressure less than 120 mm Hg
- Diastolic Less than 80 mmHg
Individuals with normal blood pressure should continue healthy lifestyle habits to maintain these levels.
Elevated Blood Pressure
- Systolic: 120–129 mmHg
- Diastolic: Less than 80 mmHg
At this stage, the risk of developing hypertension increases if preventive measures are not taken. Lifestyle modifications like reducing salt intake, increasing physical activity, and managing stress are recommended
Stage 1 Hypertension
- Systolic: 130–139 mmHg
- Diastolic: 80–89 mmHg
Patients in stage 1 are at a significantly increased risk of cardiovascular events such as heart attack and stroke. Treatment usually starts with lifestyle changes, and in some cases, medication may be prescribed depending on overall cardiovascular risk [1].
Stage 2 Hypertension
- Systolic: 140 mmHg or higher
- Diastolic: 90 mmHg or higher
At this stage, lifestyle modifications must be combined with antihypertensive medications. Without intervention, Stage 2 hypertension can lead to organ damage affecting the heart, kidneys, eyes, and brain [3].
Hypertensive Crisis
- Systolic: Higher than 180 mmHg
- Diastolic: Higher than 120 mmHg
This is a medical emergency requiring immediate treatment. Symptoms may include chest pain, shortness of breath, vision problems, confusion, and stroke-like symptoms [4]. Immediate hospitalization and intravenous medication are often needed.
Importance of Early Detection of Blood Pressure
Catching hypertension in its early stages can prevent progression to more dangerous levels. Regular blood pressure monitoring, even when feeling healthy, is critical. Home blood pressure monitors are increasingly recommended for patients at risk [2] and can help to classify them into different stages of hypertension.
Lifestyle changes across all stages is recommended
Regardless of the stage, adopting a heart-healthy lifestyle benefits everyone. These healthy habits are
- Reduce dietary salt
- Follow the DASH diet
- Engage in regular exercise (at least 150 minutes per week)
- Maintain a healthy weight
- Limit alcohol consumption
- Manage stress effectively
- Quit smoking
Even modest improvements in these areas can lead to substantial blood pressure reductions and long-term cardiovascular protection [3].
Conclusion
Understanding the stages of hypertension allows individuals and healthcare providers to understand the presence or absence of hypertension and if present, how severe the condition is. It helps both individuals and healthcare providers to act early, tailor treatments, and prevent severe complications.
Small, consistent changes in lifestyle, combined with proper medical care, can make a significant difference in maintaining healthy blood pressure levels over a lifetime.
References
[1] Whelton PK, Carey RM, et al. 2017 ACC/AHA Hypertension Guideline. Journal of the American College of Cardiology. 2018;71(19):e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
[2] American Heart Association. Understanding Blood Pressure Readings. 2023. Available at: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
[3] Carey RM, Muntner P, Bosworth HB, Whelton PK. Prevention and Control of Hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology. 2018;72(11):1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008
[4] Varon J. Diagnosis and Management of Hypertensive Crisis. The American Journal of Cardiology. 2018;122(10):1794–1801. https://doi.org/10.1016/j.amjcard.2018.07.028
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