Blood pressure is the force of blood pushing against artery walls as your heart pumps. The American Heart Association (AHA) provides guidelines that serve as a framework for understanding blood pressure readings and managing health risks. By establishing clear categories and evidence-based recommendations, the AHA empowers people to take proactive steps toward maintaining cardiovascular wellness and helps in the prevention, detection, and treatment of high blood pressure.
Understanding the Blood Pressure Categories
The American Heart Association, along with the American College of Cardiology (ACC), established five categories to classify blood pressure readings. These categories are based on two numbers: systolic pressure (the top number), which measures pressure when the heart beats, and diastolic pressure (the bottom number), which measures pressure when the heart rests between beats. Understanding which category your reading falls into is the first step toward managing your cardiovascular health.
A reading of less than 120/80 millimeters of mercury (mm Hg) is considered Normal. This range indicates that your blood pressure is in a healthy zone, and you should maintain heart-healthy habits like a balanced diet and regular exercise. The next category is Elevated, where the systolic number is between 120 and 129 mm Hg and the diastolic number is less than 80 mm Hg. People in this category are at risk of developing high blood pressure unless they take steps to control the condition.
Hypertension Stage 1 is defined by a systolic reading between 130 and 139 mm Hg or a diastolic reading between 80 and 89 mm Hg. At this stage, doctors are likely to recommend lifestyle changes and may consider prescribing medication based on your risk of cardiovascular disease. Hypertension Stage 2 is more serious, with readings consistently at 140/90 mm Hg or higher. For this stage, healthcare professionals prescribe a combination of blood pressure medications and lifestyle modifications.
The most severe category is a Hypertensive Crisis, with readings exceeding 180/120 mm Hg, which requires immediate medical attention. If you get a reading this high, wait five minutes and test again. If it remains high, contact your doctor; if you have symptoms like chest pain, shortness of breath, or vision changes, call 911. The guidelines lowered the threshold for a hypertension diagnosis, allowing for earlier intervention.
How to Measure Blood Pressure Correctly
An accurate blood pressure reading is necessary for proper diagnosis, and a single high reading does not mean you have hypertension. Before a measurement, avoid caffeine, exercise, and smoking for at least 30 minutes. You should also have an empty bladder and rest quietly for about five minutes beforehand.
Proper positioning is necessary for an accurate measurement. You should be seated with your back supported and feet flat on the floor, not with your legs crossed, as this can increase the reading. Your arm should be supported on a flat surface, like a table, with the blood pressure cuff at heart level, as incorrect arm height can alter the reading.
Using the correct cuff size is also important. The cuff’s bladder should encircle at least 80% of your arm’s circumference and be placed on bare skin, not over clothing. A cuff that is too small can lead to an artificially high reading, while one that is too large may give a falsely low reading. For a reliable result, take two or three readings about one minute apart and average the results. At an initial visit, blood pressure should be measured in both arms, and the arm with the higher reading should be used for future measurements.
Lifestyle and Home Remedies
Managing blood pressure for anyone with readings above normal begins with lifestyle modifications. A primary focus is on diet, specifically the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH diet emphasizes fruits, vegetables, whole grains, and low-fat dairy products while limiting red meat, sweets, and sugary drinks. A key component is reducing sodium intake while increasing potassium, which helps to counterbalance sodium’s effect on blood pressure.
Physical activity is another pillar of blood pressure control. The AHA recommends at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking or cycling, per week. This activity can be broken down into smaller sessions. Regular physical activity helps lower blood pressure and assists with weight management, as losing even a small amount of weight can produce a meaningful reduction in blood pressure.
Limiting alcohol consumption is also advised. The AHA suggests that men have no more than two drinks per day and women no more than one. For reference, one drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits. Quitting smoking is another impactful change, as smoking damages blood vessels and raises blood pressure.
Medical Intervention and Treatment Plans
While lifestyle changes are fundamental, medical intervention is considered when blood pressure reaches certain thresholds. The decision to start medication is based on both the numbers and an individual’s overall cardiovascular risk. For those with Hypertension Stage 1 (130-139/80-89 mm Hg), the approach varies. If a person has already had a cardiovascular event like a heart attack or stroke, or is at high risk for one, medication is recommended alongside lifestyle changes.
To determine this risk, doctors use the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator, which estimates the 10-year risk of a cardiovascular event. If a patient with Stage 1 hypertension has a 10-year risk below 10%, treatment begins with three to six months of lifestyle changes to see if their numbers can be lowered without medication.
For individuals with Hypertension Stage 2 (140/90 mm Hg or higher), guidelines recommend starting medication and lifestyle modifications simultaneously. The goal for most adults undergoing treatment is to achieve a blood pressure reading below 130/80 mm Hg. The specific medication and treatment plan are personalized with a healthcare provider, considering other health conditions and potential side effects.