Hypertension, commonly known as high blood pressure, is a widespread health condition often referred to as the “silent killer” because it typically presents without noticeable symptoms. It can affect individuals across all age groups, quietly damaging blood vessels over time. Guidelines for managing hypertension provide a structured approach for healthcare providers and patients, helping prevent and address associated health problems like heart attack, stroke, and kidney disease.
Evolution of Hypertension Guidelines
Medical understanding and recommendations for hypertension management have evolved. Historically, the Joint National Committee (JNC) reports played a role in shaping hypertension management in the United States. Reports like JNC 7 and JNC 8 provided evidence-based recommendations on treatment thresholds, goals, and medications, guiding clinical practice.
The JNC 8 report, published in 2014, was the last in this series, introducing more lenient blood pressure targets for certain populations compared to JNC 7. More recent guidelines from organizations like the American Heart Association (AHA) and American College of Cardiology (ACC) have since become widely adopted. The 2017 ACC/AHA Hypertension Guideline redefined blood pressure categories and treatment thresholds.
Understanding Blood Pressure Categories
Blood pressure measurements consist of two numbers: systolic and diastolic pressure. Systolic pressure, the upper number, indicates the pressure in your arteries when your heart beats. Diastolic pressure, the lower number, represents the pressure in your arteries when your heart rests between beats.
Current standard blood pressure categories, outlined by the 2017 ACC/AHA guidelines, define specific ranges. Normal blood pressure is considered less than 120 mmHg systolic and less than 80 mmHg diastolic. Elevated blood pressure falls between 120-129 mmHg systolic and less than 80 mmHg diastolic.
Stage 1 Hypertension is defined as a systolic pressure between 130-139 mmHg or a diastolic pressure between 80-89 mmHg. Stage 2 Hypertension is diagnosed when systolic pressure is 140 mmHg or higher, or diastolic pressure is 90 mmHg or higher. A Hypertensive Crisis, a medical emergency, occurs when systolic pressure is over 180 mmHg and/or diastolic pressure is over 120 mmHg.
Diagnosing Hypertension
Diagnosing hypertension requires multiple measurements over time to confirm consistent elevation. Proper measurement techniques are important for accurate readings, including ensuring the patient is seated correctly, using an appropriately sized blood pressure cuff, and avoiding caffeine or exercise before the measurement.
Home blood pressure monitoring plays a role in diagnosis, providing a comprehensive picture of a person’s blood pressure outside of a clinical setting. This helps identify “white coat hypertension,” where blood pressure is elevated only in a medical environment but normal at home. Conversely, “masked hypertension” involves normal office readings but consistently high readings when measured elsewhere, carrying a similar cardiovascular disease risk to sustained hypertension.
Managing Hypertension
Managing hypertension involves a dual approach, often beginning with lifestyle modifications and progressing to medication if necessary. Lifestyle changes are the primary treatment approach and can reduce blood pressure. These include adopting a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy.
Regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise weekly, is also recommended. Other lifestyle changes that contribute to blood pressure control include:
- Maintaining a healthy weight.
- Limiting sodium intake to less than 2,300 mg daily.
- Moderating alcohol consumption to no more than two drinks daily for men and one for women.
- Practicing stress management techniques.
If lifestyle changes are insufficient to reach target blood pressure goals, medication may be prescribed. Common classes of drugs used include thiazide diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers. Adherence to prescribed medication is important for effective long-term blood pressure control and to reduce the risk of associated complications.