Should I treat a blood pressure reading of 120/90 mmHg (hypertension)?

Blood Pressure of 120/90 mmHg Does Not Require Medication Treatment

A blood pressure reading of 120/90 mmHg does not require antihypertensive medication treatment at this time, as it falls within the high-normal blood pressure range rather than true hypertension. 1

Classification of This Blood Pressure Reading

According to the 2020 International Society of Hypertension (ISH) guidelines, this blood pressure reading can be classified as follows:

• Systolic BP of 120 mmHg: Within normal range (<130 mmHg)
• Diastolic BP of 90 mmHg: At the threshold for hypertension (≥90 mmHg)

When there is a discrepancy between systolic and diastolic classifications, the higher category should be applied, placing this reading in the "high-normal" category 1.

Recommended Approach

Immediate Steps

• Take two additional blood pressure readings during the same visit
• Use the average of these readings for clinical decision-making
• Ensure proper measurement technique:
  • Use a validated device with appropriate cuff size
  • Patient should be seated quietly for 5 minutes before measurement
  • Measure BP in both arms at first visit

Follow-up Actions

• Confirm with home blood pressure monitoring or 24-hour ambulatory monitoring
  • Home BP threshold for hypertension: ≥135/85 mmHg
  • 24-hour ambulatory BP threshold: ≥130/80 mmHg

Lifestyle Modifications

While medication is not indicated at this time, implement these evidence-based lifestyle changes:

• Weight loss if overweight/obese
• Adopt DASH dietary pattern (rich in fruits, vegetables, whole grains, low-fat dairy)
• Reduce sodium intake (<2000 mg/day)
• Increase physical activity (150+ minutes/week of moderate activity)
• Limit alcohol consumption
• Smoking cessation if applicable

These lifestyle modifications can effectively lower blood pressure by 3-4 mmHg systolic and potentially normalize your blood pressure 2, 3.

When to Consider Medication

Medication would be indicated if:

1. Blood pressure rises to ≥140/90 mmHg on repeated measurements
2. Home BP readings are consistently ≥135/85 mmHg
3. You have high cardiovascular risk factors (diabetes, chronic kidney disease, cardiovascular disease, or target organ damage)

Monitoring Plan

• Recheck blood pressure in 3-6 months
• Consider more frequent monitoring if you have other cardiovascular risk factors
• Implement home blood pressure monitoring if available

Important Caveats

• A single elevated diastolic reading warrants monitoring but not immediate medication
• The isolated diastolic elevation may be positional or situational (white coat effect)
• Consistent readings above 140/90 mmHg on multiple occasions would define true hypertension requiring treatment 1
• If you have diabetes, chronic kidney disease, or established cardiovascular disease, treatment thresholds may be lower

By following these recommendations, you can effectively manage your blood pressure through lifestyle modifications while appropriately monitoring for any progression that might require pharmacological intervention in the future.