What type of blood pressure is 145/84 and does it require medication?

Blood Pressure Classification and Management for 145/84 mmHg

A blood pressure reading of 145/84 mmHg is classified as Stage 1 Hypertension according to the 2017 ACC/AHA guidelines, and medication is recommended only if the patient has high cardiovascular risk factors, diabetes, chronic kidney disease, or known cardiovascular disease. 1

Blood Pressure Classification

• 145/84 mmHg falls into Stage 1 Hypertension (systolic BP 140-159 mmHg, diastolic BP 80-89 mmHg) according to the 2017 ACC/AHA guidelines 1
• This classification represents an update from previous guidelines which used 140/90 mmHg as the threshold for hypertension diagnosis 1
• The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines classify this as Grade 1 Hypertension (140-159/90-99 mmHg) 1

Treatment Recommendations

Lifestyle Modifications (First-Line for All Patients)

• All patients with this blood pressure reading should receive counseling on lifestyle modifications 2
• These include weight loss, healthy dietary pattern with low sodium and high potassium, physical activity, and moderation of alcohol consumption 2
• Lifestyle modifications can reduce systolic BP by 5-10 mmHg and enhance the efficacy of pharmacologic therapy 2

Medication Recommendations Based on Risk Stratification

• For patients WITHOUT high cardiovascular risk:

  • Lifestyle modifications for several weeks to months before considering medication 1
  • Monitor blood pressure regularly during this period 1

• For patients WITH high cardiovascular risk factors:

  • Initiate antihypertensive medication immediately along with lifestyle modifications 1
  • High-risk factors include: age ≥65 years, diabetes mellitus, chronic kidney disease, known cardiovascular disease, or 10-year ASCVD risk ≥10% 1

Medication Selection (When Indicated)

• First-line medications include:
  • Thiazide or thiazide-like diuretics (e.g., hydrochlorothiazide, chlorthalidone)
  • ACE inhibitors or ARBs (e.g., lisinopril, candesartan)
  • Calcium channel blockers (e.g., amlodipine) 2
• For patients whose BP is >20 mmHg above systolic goal or >10 mmHg above diastolic goal, consider initiating therapy with two agents 1

Treatment Targets

• For most adults under 65 years: target BP <130/80 mmHg 2
• For adults 65 years and older: target systolic BP <130 mmHg with no specific diastolic target 2, 3
• European guidelines suggest a target of <140/90 mmHg for most patients 1

Common Pitfalls and Caveats

• Single elevated BP reading is insufficient for diagnosis - confirmation requires multiple readings on different occasions 1
• White coat hypertension (elevated BP only in clinical settings) should be ruled out with home or ambulatory BP monitoring 1
• Medication non-adherence is a common cause of uncontrolled hypertension 4
• Elderly patients may require more gradual BP reduction to avoid adverse effects 3
• Isolated systolic hypertension in young individuals may require different management approaches 1

Follow-up Recommendations

• For patients started on medication: follow-up within 2-4 weeks to assess response 5
• For patients on lifestyle modifications only: follow-up within 3-6 months 1
• Consider home BP monitoring to track progress and improve adherence 5

The decision to treat with medication should be based on overall cardiovascular risk assessment rather than BP values alone, as this approach has been shown to better match intensive BP control with patient risk 1.