Managing 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. Guidelines released by the JNC, which are summarized here, offer guidance on who should be treated and what sort of treatment may be best. The committee’s guidelines, issued in May 2003, emphasize the importance of tackling escalating blood pressure earlier rather than later, thereby heading off heart disease, stroke, and kidney damage. You should speak to your doctor to see how these guidelines apply to your situation.

If your reading is normal

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”). You should speak to your doctor to see how these guidelines apply to your situation.

Prehypertension

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, experts recommend that doctors and patients consider certain medications beginning at pressures of 130/80 mm Hg. You should speak to your doctor to see how these guidelines apply to your situation.

Stage 1 hypertension

Your systolic blood pressure is between 140–159 or your diastolic pressure is between 90–99, 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 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. The JNC guidelines also recommend that African-Americans, who are at a higher-than-average risk for hypertension-related complications, begin with a two-drug regimen if blood pressure readings top 145/90 mm Hg. Your doctor is the best source of information in learning how these guidelines apply to your situation.

No matter what your blood pressure is currently, it’s important to engage in healthy habits, including watching your weight, eating a diet rich in fruits and vegetables, exercising regularly, and drinking alcohol in moderation.

Stage 2 hypertension

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 medication. Your doctor is the best source of information in learning how these guidelines apply to your situation.