High blood pressure (hypertension) guidelines

Millions of people have what is called "prehypertension" according to high blood pressure guidelines from the U.S. National Institutes of Health.

The guidelines are included in the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.¹

High blood pressure guidelines

Blood pressure	Classification
140/90 or above	High
120/80 to 139/89	Prehypertension
119/79 or below	Normal

Key points from the guidelines:

• If you have a blood pressure of 120 to 139 systolic (the upper number in a blood pressure measurement) over 80 to 89 diastolic (lower number), you are considered prehypertensive. You need to begin lifestyle changes to lower your risk for stroke, heart disease, and other complications of high blood pressure. Lifestyle changes include losing excess weight, exercising, limiting alcohol, following a heart-healthy diet, cutting back on salt, and quitting smoking.
• The increase in stroke and heart disease risk begins at blood pressures as low as 115/75 millimeters of mercury (mm Hg) and doubles with each increase of 20 mm Hg systolic blood pressure and 10 mm Hg diastolic. For example, if your blood pressure were to increase from 115/75 mm Hg to 135/85 mm Hg, your risk of stroke and heart attack would double.
• The lifetime risk for high blood pressure is much greater than previously thought. Ninety percent of those who, at age 55, do not have hypertension will eventually develop it.
• If you are older than 50, a systolic blood pressure over 140 mm Hg is a more important risk factor for stroke and heart disease than your diastolic blood pressure.
• Most people who need medicine to control their high blood pressure should take a thiazide-type diuretic either alone or with another hypertension medicine. You may need initial treatment with other classes of medicines-angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, or calcium channel blockers-if you have other conditions, such as diabetes, heart failure, or chronic kidney disease.
• Most people with high blood pressure will need two or more medicines, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mm Hg, the goal for people with uncomplicated hypertension. If you have other conditions, such as diabetes, or chronic kidney disease, your goal blood pressure is lower: 130/80 mm Hg.

Citations

1. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.