Stages of Hypertension Based on the Latest Health Guidelines

In the Philippines, hypertension and cardiovascular disease (CVD) are responsible for over a quarter of all deaths. Despite the availability of blood pressure monitors and medications, many Filipinos continue to live with hypertension. Additionally, many people may not even know they have hypertension until it has already become a serious problem. This is why knowing the stages of hypertension is important for your health. Learn more about the latest hypertension staging and what each stage means.

Measuring Blood Pressure and Hypertension

As a short introduction, hypertension means there is high pressure inside the blood vessels. In contrast, hypotension is abnormally low blood pressure.

Blood pressure is expressed as a fraction in millimeters of mercury (mmHg). The upper number indicates the systolic (when the heart contracts) pressure and the lower number indicates the diastolic (when the heart relaxes) pressure.

Knowing your blood pressure throughout the day is essential to accurately diagnose and manage hypertension. Therefore, understanding how to take and read blood pressure is important. Luckily, blood pressure can be measured at home using a sphygmomanometer (blood pressure cuff). If the systolic pressure or diastolic pressure falls under different stages, the higher stage is generally used.

Stages of Hypertension

2017 ACC/AHA High Blood Pressure Guidelines

Elevated blood pressure

The distinction between normal and elevated blood pressure can be confusing for some. Based on the latest guidelines from the American Heart Association, elevated blood pressure is when the systolic pressure is above 120 but below 130 mmHg. The diastolic pressure is still normal or below 80 mmHg.

“Prehypertension” is another term related to elevated blood pressure. While occasionally elevated blood pressure is not a problem, it may increase the risk of developing stage 1 hypertension later on. If you have elevated blood pressure, your doctor will encourage you to adjust your diet and lifestyle but medications most likely won’t be necessary.

Stage 1 hypertension

Next, stage 1 hypertension is when systolic pressure is above 130 mmHg and diastolic pressure is over 80 mmHg. Doctors or hospitals may follow the JNC 8 guidelines for staging hypertension. In this case, 140/90 mmHg to 159/99 mmHg is considered stage 1 hypertension. This stage is when a person is officially diagnosed with hypertension.

At this stage, patients may not feel any symptoms such as headaches or dizziness. Therefore, diagnosis relies mainly on blood pressure measurements and other history. Doctors will recommend diet, lifestyle, and medications to manage blood pressure especially if the patient has co-morbidities like diabetes, atherosclerosis, or CKD. However, not all patients require medications if diet and exercise are enough.

Stage 2 hypertension

When someone with stage 1 hypertension does not control their blood pressure, their condition can worsen. Stage 2 is blood pressure that is regularly between 140/90 mmHg and 180/120 mmHg. Unfortunately, if your blood pressure is 140/80 mmHg, it is still stage 2. Based on JNC 8 guidelines, stage 2 is a reading of 160/100 mmHg or higher.

At this stage, a patient may or may not feel any symptoms of hypertension. At higher pressures, symptoms such as dizziness, headaches, flushing, and chest pain may occur.

Compared to the other stages of hypertension, diet and lifestyle changes are not enough. Stage 2 hypertension typically requires one or more maintenance medications, oftentimes for life-long treatment. Additional medications will be prescribed if there are other health risks.

Hypertensive crisis

Lastly, patients with extremely high blood pressure above 180/120 mmHg are in a hypertensive crisis. This stage is a medical emergency because too much pressure can cause serious damage to the blood vessels and the organs they supply. At high pressures, thin or hardened blood vessels can burst, resulting in aneurysms, hemorrhage, and stroke. If you see extremely elevated blood pressure readings, it is important to seek medical attention right away.

Hypertensive crisis is usually a result of not taking the necessary medications or lifestyle changes. This is why it is important to regularly check your blood pressure as well as get check ups, even if you “feel fine.” Even if you are properly taking your medications, increasing blood pressure is a sign that the dose or type of drug needs to be changed.

Learn more about Hypertension here.