What to Do About Blood Pressure of 150/100 mmHg
You need to start antihypertensive medication immediately while simultaneously implementing lifestyle modifications, as your blood pressure of 150/100 mmHg meets the threshold for pharmacological treatment. 1
Confirm the Diagnosis First
Before starting treatment, verify this is sustained hypertension rather than an isolated reading:
- Obtain home blood pressure measurements (≥135/85 mmHg confirms hypertension) or 24-hour ambulatory monitoring (≥130/80 mmHg confirms hypertension) 1, 2
- Take at least two measurements at each of several visits, with the patient seated and arm at heart level 1
- Rule out "white coat hypertension" if office readings are consistently elevated but home readings are normal 1
Initial Investigations Required
Perform these tests before starting medication to assess cardiovascular risk and detect secondary causes:
- Urine dipstick for blood and protein 1
- Serum electrolytes, creatinine, and estimated glomerular filtration rate 1
- Fasting blood glucose 1
- Lipid panel (total cholesterol and HDL ratio) 1
- 12-lead electrocardiogram 1
Pharmacological Treatment: Start Combination Therapy
Begin with two-drug combination therapy immediately rather than monotherapy, as your BP is significantly elevated (≥150/100 mmHg) 1, 2:
Preferred First-Line Combinations:
ACE inhibitor or ARB + Calcium channel blocker (e.g., lisinopril 10mg + amlodipine 5mg daily) 1, 3, 2
ACE inhibitor or ARB + Thiazide diuretic (e.g., lisinopril 10mg + hydrochlorothiazide 12.5-25mg daily) 1, 2, 4
- Effective for volume-dependent hypertension 3
Calcium channel blocker + Thiazide diuretic (e.g., amlodipine 5mg + hydrochlorothiazide 12.5-25mg daily) 1, 2
- May be more effective if you are of Black ancestry 3
Use fixed-dose single-pill combinations when available to improve adherence 2
Blood Pressure Targets
- Minimum acceptable target: <140/90 mmHg 1, 2
- Optimal target: <130/80 mmHg if well tolerated 1, 2
- Achieve target within 3 months of starting treatment 1, 2
Essential Lifestyle Modifications (Start Immediately)
These provide additive BP reductions of 10-20 mmHg and should be implemented alongside medication, not instead of it 1, 2:
- Weight loss: Achieve BMI 20-25 kg/m² through reduced fat and calorie intake 1, 2
- Sodium restriction: Limit to <2g/day by eliminating salty foods and not adding salt during cooking 1, 2, 4
- Increase potassium intake: Consume more fruits and vegetables 1, 4
- Regular aerobic exercise: At least 30 minutes of brisk walking on at least 3 days per week 1, 2, 5
- Alcohol limitation: <21 units/week for men, <14 units/week for women 1, 2
- Stop smoking if applicable 1
Monitoring Schedule
- Recheck BP within 2-4 weeks after starting medication 1, 2
- Monitor serum potassium and creatinine 2-4 weeks after initiating ACE inhibitors, ARBs, or diuretics 1, 2
- See your physician every 1-3 months until BP is controlled 2
- Continue home BP monitoring to confirm treatment effectiveness 1
If Blood Pressure Remains Uncontrolled
If BP stays ≥140/90 mmHg after optimizing doses of your initial two medications:
- Add a third agent from the remaining drug class (thiazide diuretic if you started with ACE inhibitor + calcium channel blocker) 1, 3, 2
- The combination of ACE inhibitor + calcium channel blocker + thiazide diuretic represents guideline-recommended triple therapy 3, 4
Critical Pitfalls to Avoid
- Never delay medication while attempting lifestyle changes alone—both must start simultaneously at your BP level 2
- Never start with monotherapy—combination therapy is more effective and recommended from the outset for BP ≥150/100 mmHg 1, 2
- Never combine two drugs from the same class (e.g., ACE inhibitor + ARB)—this increases adverse events without benefit 1, 3, 2
- Do not use immediate-release nifedipine for BP lowering—it can cause dangerous rapid drops 6
When to Seek Urgent Care
Seek immediate medical attention if you develop: