From the Guidelines
Stage 2 hypertension is defined as a blood pressure of 140/90 mmHg or higher.
Key Characteristics of Stage 2 Hypertension
- Blood Pressure Threshold: The blood pressure threshold for stage 2 hypertension is a systolic blood pressure (SBP) of 140 mmHg or higher, or a diastolic blood pressure (DBP) of 90 mmHg or higher 1.
- Treatment Recommendations: For stage 2 hypertension, nonpharmacological therapy and blood pressure-lowering medication are recommended 1.
- Risk Assessment: Stage 2 hypertension is associated with an increased risk of cardiovascular disease (CVD), and the risk gradient is consistent across subgroups defined by sex and race/ethnicity 1.
- Lifestyle Modifications: Lifestyle modifications, such as promoting optimal lifestyle habits, are recommended for all patients with stage 2 hypertension 1.
- Medication Therapy: Medication therapy, including the use of two antihypertensive agents of different classes, may be considered for patients with stage 2 hypertension, especially those with a blood pressure of 160/100 mmHg or higher 1. Some of the key points to consider when managing stage 2 hypertension include:
- Assessing and optimizing adherence to therapy
- Considering intensification of therapy
- Monitoring the response to therapy
- Reinforcing the importance of adherence and treatment
- Assisting with treatment to achieve blood pressure targets 1.
From the Research
Definition of Stage 2 Hypertension
- Stage 2 hypertension is defined as a systolic blood pressure (SBP) of 160 mmHg or higher, or a diastolic blood pressure (DBP) of 100 mmHg or higher 2, 3, 4, 5, 6.
- According to the 2017 American College of Cardiology/American Heart Association blood pressure guidelines, stage 2 hypertension is categorized as an SBP of 140 mmHg or higher, or a DBP of 90 mmHg or higher 6.
Characteristics of Patients with Stage 2 Hypertension
- Patients with stage 2 hypertension often have comorbidities such as diabetes mellitus, with a prevalence of 48.9% in one study 2.
- The mean age of patients with stage 2 hypertension is around 55 years, with most patients aged between 30 and 60 years 2.
- Stage 2 hypertension is associated with an increased risk of heart failure and atrial fibrillation, with hazard ratios of 2.05 and 1.52, respectively, compared to patients with normal blood pressure 6.
Treatment of Stage 2 Hypertension
- Combination therapy is often used to treat stage 2 hypertension, with commonly prescribed medications including angiotensin receptor blockers, angiotensin-converting-enzyme inhibitors, and thiazide-like diuretics 2, 3, 4, 5.
- The use of multiple antihypertensive agents is associated with improved blood pressure control, with an adjusted odds ratio of 3.54 for achieving blood pressure control at 3 months 4.
- Increasing from single-class to dual-class antihypertensive therapy is associated with a 42% increased odds of achieving blood pressure control 5.