What does a blood pressure reading of 145/94 indicate and how should it be managed?

Management of Blood Pressure Reading 145/94 mmHg

A blood pressure reading of 145/94 mmHg indicates Stage 1 hypertension that requires immediate lifestyle modifications and pharmacological treatment to reduce cardiovascular risk. 1

Blood Pressure Classification

The reading of 145/94 mmHg falls into the Stage 1 hypertension category according to current guidelines:

• Systolic BP of 145 mmHg exceeds the threshold of 140 mmHg
• Diastolic BP of 94 mmHg exceeds the threshold of 90 mmHg

This classification requires confirmation through repeated measurements or home/ambulatory blood pressure monitoring to establish a diagnosis of hypertension 1.

Immediate Management Steps

1. Confirm the Diagnosis

• Verify the reading with at least one additional measurement during the same visit
• Recommend home blood pressure monitoring or 24-hour ambulatory monitoring to confirm the diagnosis
• A diagnosis of hypertension is confirmed if home BP readings are ≥135/85 mmHg or 24-hour ambulatory BP readings are ≥130/80 mmHg 1

2. Risk Assessment

• Evaluate for cardiovascular disease risk factors (diabetes, dyslipidemia, smoking, obesity)
• Check for evidence of target organ damage (heart, kidneys, eyes, brain)
• Assess for secondary causes of hypertension if clinically indicated

Treatment Approach

Lifestyle Modifications

Implement the following lifestyle changes immediately:

• Weight reduction: 5-20 mmHg reduction per 10kg weight loss 2
• DASH diet: Rich in fruits, vegetables, and whole grains; can reduce BP by 8-14 mmHg 2
• Sodium restriction: Limit to 2.4g per day for 2-8 mmHg reduction 2
• Physical activity: 150 minutes/week of moderate-intensity exercise for 4-9 mmHg reduction 2, 3
• Alcohol moderation: Limit consumption for 2-4 mmHg reduction 2
• Smoking cessation: Important for overall cardiovascular risk reduction 2

Pharmacological Therapy

For a BP of 145/94 mmHg, drug therapy should be initiated immediately along with lifestyle modifications 1, particularly because:

1. This level of BP elevation significantly increases cardiovascular risk
2. The European Society of Cardiology recommends BP reduction to at least below 140/90 mmHg in all hypertensive patients 1

First-line Medication Options:

• Non-black patients: Start with low-dose ACE inhibitor or ARB 1, 2
• Black patients: Consider calcium channel blocker or thiazide/thiazide-like diuretic 1, 2

Medication Titration:

1. Start with monotherapy at low dose
2. If BP goal not achieved within 2-4 weeks, increase to full dose
3. If still not controlled, add a second agent (typically combining ACE inhibitor/ARB with calcium channel blocker or thiazide diuretic) 1, 2
4. Continue to adjust therapy until target BP is reached

Target Blood Pressure

• General target: <140/90 mmHg 1
• For high-risk patients (diabetes, CKD, or established CVD): <130/80 mmHg 1, 2

Follow-up and Monitoring

• Schedule follow-up within 2-4 weeks to assess response to therapy
• Monitor BP control monthly until target is reached 2
• Once controlled, follow up every 3-5 months 2
• For patients on ACE inhibitors, ARBs, or diuretics: Check serum creatinine/eGFR and potassium at baseline and periodically 2

Common Pitfalls to Avoid

1. Therapeutic inertia: Failing to intensify treatment when BP remains above target
2. White coat hypertension: Relying solely on office measurements without home or ambulatory monitoring
3. Inadequate dosing: Using suboptimal medication doses before adding additional agents
4. Medication non-adherence: Not addressing potential barriers to medication compliance
5. Ignoring lifestyle modifications: Focusing only on medications without emphasizing non-pharmacological approaches

By implementing this comprehensive approach to managing a blood pressure of 145/94 mmHg, cardiovascular risk can be significantly reduced, as studies have shown that achieving BP control to <140/90 mmHg is associated with lower rates of stroke, myocardial infarction, and heart failure 1.