What should be done for elevated blood pressure with readings of 116/87 mmHg?

Blood Pressure 116/87 mmHg: Elevated Diastolic Requiring Lifestyle Intervention

Your blood pressure reading of 116/87 mmHg represents elevated diastolic blood pressure (≥80 mmHg) and should be managed with immediate lifestyle modifications, with close monitoring to determine if pharmacological therapy becomes necessary. 1, 2

Blood Pressure Classification

Your reading falls into a specific category:

• Systolic BP 116 mmHg: Normal (below 120 mmHg) 1
• Diastolic BP 87 mmHg: Elevated (≥80 mmHg but <90 mmHg) 1
• This pattern indicates isolated diastolic elevation, which still carries cardiovascular risk and requires intervention 1

Immediate Actions Required

1. Confirm the Reading

• Repeat measurements on at least 2-3 separate occasions using a validated automated upper arm cuff device with appropriate cuff size 1
• Consider home blood pressure monitoring (target <135/85 mmHg at home) or 24-hour ambulatory monitoring (target <130/80 mmHg) to confirm the elevation and rule out white coat effect 1
• Measure BP in both arms simultaneously at first visit; use the arm with higher readings for subsequent measurements 1

2. Assess Cardiovascular Risk

You need evaluation for: 1, 2

• 10-year cardiovascular disease risk (using validated risk calculators)
• High-risk conditions: diabetes, chronic kidney disease (eGFR <60), established cardiovascular disease, hypertension-mediated organ damage, or familial hypercholesterolemia 1
• Risk modifiers: family history of premature CVD, chronic inflammatory conditions, or abnormal risk tool tests 1

Treatment Strategy

Lifestyle Modifications (Start Immediately)

All patients with BP >120/80 mmHg require lifestyle intervention. 1 Implement these evidence-based changes:

Weight Management

• Achieve and maintain BMI 20-25 kg/m² if overweight 1, 2
• Weight loss produces approximately 1 mmHg reduction per kg lost 3

Dietary Changes

• Adopt DASH (Dietary Approaches to Stop Hypertension) or Mediterranean dietary pattern: emphasize fruits, vegetables, whole grains, low-fat dairy, reduced saturated fat and cholesterol 1, 4
• Reduce sodium intake to <2,300 mg/day (ideally <1,500 mg/day), which can lower BP by 5-6 mmHg 3, 4
• Increase potassium intake through diet (target 3,500-5,000 mg/day from food sources) 1, 4

Physical Activity

• 150 minutes/week of moderate-intensity aerobic exercise (e.g., brisk walking) OR 75 minutes/week of vigorous exercise 1, 2
• Add resistance training 2-3 times/week 1, 2
• Regular exercise can reduce BP by approximately 5 mmHg 5

Alcohol Moderation

• Limit to ≤2 standard drinks/day for men, ≤1 drink/day for women (maximum 14/week for men, 9/week for women) 1, 3

When to Start Medication

The decision depends on your cardiovascular risk profile: 1, 2

Start Medication at 3 Months if:

• BP remains ≥130/80 mmHg after lifestyle modifications AND you have:
  • 10-year CVD risk ≥10%, OR
  • 10-year CVD risk 5-10% plus risk modifiers, OR
  • High-risk conditions (diabetes, CKD, established CVD, hypertension-mediated organ damage) 1

Continue Lifestyle Modifications Only if:

• BP improves to <130/80 mmHg with lifestyle changes 1
• Low cardiovascular risk (<5% 10-year risk) and BP remains 120-129/70-79 mmHg 1

Medication Selection (If Needed)

If pharmacological therapy becomes necessary: 1, 2

First-line combination therapy:

• ACE inhibitor (e.g., lisinopril) or ARB (e.g., valsartan) PLUS dihydropyridine calcium channel blocker (e.g., amlodipine) 1, 6, 7
• Alternative: RAS blocker plus thiazide-like diuretic (e.g., chlorthalidone) 1
• Use single-pill combinations to improve adherence 1

Target BP with treatment: 120-129/70-79 mmHg 1, 2

Monitoring Schedule

• Recheck BP in 3 months after initiating lifestyle modifications 1
• If medication started, follow-up within 2-4 weeks after each dose adjustment 2, 8
• Achieve target BP within 3 months of starting treatment 1, 8
• Consider home BP monitoring to track progress 1

Critical Pitfalls to Avoid

• Do not ignore diastolic BP ≥80 mmHg even when systolic is normal—this still increases cardiovascular risk 1
• Do not delay lifestyle modifications—these should start immediately regardless of whether medication is needed 1, 3
• Avoid therapeutic inertia—if BP remains elevated after 3 months of lifestyle changes in high-risk patients, medication must be initiated 1, 2
• Do not use monotherapy if medication is needed; combination therapy is more effective 1