First Step for Blood Pressure 136/84 mmHg
The first step is to confirm this reading by taking at least two more measurements using a validated automated upper arm cuff device with appropriate cuff size, as this blood pressure falls in the "high-normal" range (130-139/85-89 mmHg) and requires confirmation before any treatment decisions. 1
Diagnostic Confirmation
- Take 2 additional blood pressure readings during the same visit to establish an accurate baseline 1
- Use a validated automated device with the correct cuff size for the patient 1
- Measure BP in both arms simultaneously at the first visit; if there's a consistent difference, use the arm with higher readings for future measurements 1
- Consider home BP monitoring or 24-hour ambulatory BP monitoring to confirm the diagnosis, as office readings can be misleading 1
Classification and Next Steps
With a BP of 136/84 mmHg, this patient falls into the high-normal category (130-139/85-89 mmHg), which is below the hypertension threshold of ≥140/90 mmHg 1
If Confirmed High-Normal (130-139/85-89 mmHg):
- Initiate lifestyle modifications immediately as the primary intervention 1, 2
- Remeasure BP after 3 years if no other risk factors are present 1
- Do NOT start pharmacological therapy unless the patient has high cardiovascular risk factors 1
Lifestyle Modifications to Implement Now
- Dietary sodium restriction: Reduce intake to <2,300 mg/day, ideally <2,000 mg/day 3, 2
- DASH diet pattern: Increase fruits and vegetables to 8-10 servings daily, emphasize whole grains, low-fat dairy, and lean proteins 3, 4
- Increase potassium intake through dietary sources 2, 4
- Physical activity: At least 150 minutes per week of moderate-intensity aerobic exercise 3, 4
- Weight loss if overweight or obese 2, 4
- Alcohol moderation: Limit or eliminate alcohol consumption 2, 4
When to Consider Drug Therapy
Drug therapy would only be indicated if:
- BP rises to ≥140/90 mmHg on repeated measurements 1
- Patient has high cardiovascular risk factors (CVD, CKD, diabetes, organ damage, or age 50-80 years) AND BP remains ≥140/90 mmHg 1
- BP remains elevated after 3-6 months of lifestyle interventions in low-risk patients 1
Critical Pitfall to Avoid
Do not initiate antihypertensive medication at 136/84 mmHg unless confirmed hypertension (≥140/90 mmHg) is documented on multiple visits or confirmed with home/ambulatory monitoring 1. Premature medication initiation exposes patients to unnecessary side effects and costs when lifestyle modification alone is appropriate at this BP level.