From the Guidelines
The latest categories of hypertension, according to current guidelines, classify blood pressure into four main levels: Normal (less than 120/80 mmHg), Elevated (120-129/<80 mmHg), Stage 1 Hypertension (130-139/80-89 mmHg), and Stage 2 Hypertension (≥140/≥90 mmHg). This classification system, as outlined in the 2017 American College of Cardiology/American Heart Association hypertension guideline 1, lowered the threshold for hypertension diagnosis from the previous standard of 140/90 mmHg to 130/80 mmHg, meaning more people are now classified as having hypertension. The change was implemented to encourage earlier intervention and prevent cardiovascular complications, as adults with blood pressure in the range of 130-139/80-89 mmHg have an approximately 2-fold increase in cardiovascular disease (CVD) risk compared with adults with normal blood pressure 1. For those newly diagnosed with Stage 1 Hypertension, lifestyle modifications are typically recommended first, including:
- Reducing sodium intake
- Increasing physical activity
- Maintaining healthy weight
- Limiting alcohol consumption
- Following a heart-healthy diet like DASH (Dietary Approaches to Stop Hypertension) Medication may be prescribed for Stage 1 patients with additional cardiovascular risk factors or for those with Stage 2 Hypertension, with common medications including thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, with dosing individualized based on patient characteristics and response 1.
From the Research
Latest Category of Hypertension
The latest category of hypertension is defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, which categorize hypertension into several stages, including:
- Elevated blood pressure: systolic blood pressure (SBP) 120-129 mmHg and diastolic blood pressure (DBP) < 80 mmHg
- Stage 1 hypertension: SBP 130-139 mmHg or DBP 80-89 mmHg
- Stage 2 hypertension: SBP ≥ 140 mmHg or DBP ≥ 90 mmHg 2
Key Characteristics
Some key characteristics of the latest category of hypertension include:
- Increased risk of cardiovascular disease (CVD) events, such as coronary heart disease, heart failure, and stroke 3
- Association with increased risk of CVD morbidity and mortality 3, 4
- Importance of lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, as first-line therapy 3, 4
- Use of antihypertensive medication, such as thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers, as first-line drug therapy 3, 5, 6
Treatment and Management
Treatment and management of hypertension typically involve:
- Lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 3, 4
- Antihypertensive medication, such as thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 3, 5, 6
- Regular monitoring of blood pressure and adjustment of treatment as needed 3, 2