How to Treat the Different Stages of Hypertension

The American Heart Association released an updated hypertension guideline in 2017 that discussed new blood pressure targets and treatment recommendations for patients with high blood pressure.

In the new hypertension guideline, the definition of hypertension was altered to reflect new targets for systolic and diastolic blood pressure measurements. These blood pressure targets help guide clinical decision making by categorizing hypertension: normal BP, elevated BP, stage 1, and stage 2.¹

Previously, high blood pressure was defined as a systolic blood pressure measurement of 140 mmHg or higher or a diastolic blood pressure measurement of 90 mmHg or higher.1 The updated guideline redefined hypertension as a systolic blood pressure measurement of 130 mmHg and greater or diastolic blood pressure measurement of 80 mmHg and beyond.1 As a result, patients with systolic BP measurements greater than or equal to 140/90 mmHg are now considered to have stage 2 hypertension.¹

There are more hypertensive patients than ever before—this widespread condition is projected to increase 8% between 2013 and 2030.² Therefore, the hypertension guideline provided new treatment recommendations that included both lifestyle changes and pharmacological strategies to help manage this condition.¹ It is key for healthcare providers to have a comprehensive understanding of how to effectively treat the various stages of hypertension to help prevent its dangerous effects.

Normal Blood Pressure

Normal blood pressure is defined as a systolic blood pressure measurement of <120 mmHg and diastolic blood pressure (BP) measurement of <80 mmHg.1 Patients with normal blood pressure levels are encouraged to continue leading a healthy lifestyle to maintain their normal BP levels and prevent the development of hypertension. Patients with normal BP measurements can have their levels evaluated annually.

Elevated Blood Pressure

Elevated blood pressure was previously called “prehypertension.” It is classified as a systolic BP measurement of 120-129 mmHg and a diastolic BP measurement of less than 80 mmHg.¹ To help prevent hypertension from progressing, it is recommended the patient implement lifestyle changes and have their blood pressure levels reassessed in 3-6 months.¹ Healthy lifestyle changes include:¹

• Following the DASH diet, which is rich in fruits, vegetables, whole grains and low-fat dairy products
• Exercising on a regular basis
• Reducing sodium intake
• Maintaining a healthy weight
• Managing stress levels
• Limiting alcohol intake
• Avoid smoking
• Obtain quality sleep

Nonpharmacological therapy alone is an effective treatment strategy in adults with elevated BP levels^{3, 4} as it can reduce systolic BP by approximately 4-11 mmHg.¹

Stage 1 Hypertension

Stage 1 hypertension is defined as a systolic BP of 130-139 and a diastolic BP of 80-89 mmHg.¹ The patient’s 10-year risk for heart disease and stroke should be assessed using the atherosclerotic cardiovascular disease (ASCVD) risk calculator to determine the appropriate treatment and follow-up schedule.¹

ASCVD risk less than 10%:

It is recommended the patient employ healthy lifestyle changes alone if their ASCVD risk is less than 10%. The patient’s BP level should be assessed in 3-6 months.¹

ASCVD greater than 10%:

Healthy lifestyle changes combined with a BP-lowering medication (single agent) is the recommended treatment if the patient’s ASCVD risk is greater than 10% or if the patient has a clinical cardiovascular disease, diabetes mellitus or chronic kidney disease. After starting treatment, the patient’s BP level should be reassessed in one month.¹ If the patient’s BP goal is met after one month, the patient can be reassessed again in 3-6 months.¹ If BP goal is not met after one month, a different medication or titration should be considered.1 The patient should continue to follow up with their physician monthly until BP level is controlled.¹

Stage 2 Hypertension

Stage 2 hypertension is defined as a systolic BP of ≥140 mmHg and a diastolic BP of ≥90 mmHg.1 A combination of healthy lifestyle changes and BP-lowering medication (two first-line agents of different classes) is the recommended care plan for patients with stage 2 hypertension.¹ If patient’s BP goal is met after one month of treatment, they can be reassessed in 3-6 months.¹ If BP goal has not been achieved after one month of treatment, a different medication or titration should be considered along with monthly follow-ups with their physician until BP is controlled.¹

Hypertensive Urgency vs Emergency

If the patient has severe BP elevation (systolic BP greater than 180 mmHg or diastolic BP greater than 120 mmHg) and does not have signs or symptoms indicating target organ damage or dysfunction they are considered a hypertensive urgency.¹ Antihypertensive drug therapy should be increased in these patients.¹

If the patient’s severe BP elevation is accompanied by new or worsening target organ damage it is considered a hypertensive emergency. ¹ Patients who have a hypertensive emergency should be admitted into an intensive care unit. An agent should be administered to reduce BP levels, and the patient’s BP should be continuously monitored.¹ If left untreated, the median survival rate is 10.4 months.⁵

Key Takeaway

There is a strong correlation between blood pressure levels and CVD risk—the higher the BP, the greater the CVD risk.¹ Therefore, it is important for healthcare providers to know how to treat the different stages of hypertension. Integrating both nonpharmacological and pharmacological treatment strategies can help manage the patient’s risk for experiencing the dangerous effects of hypertension including vision loss, heart attack or failure, stroke and kidney damage.⁶

Be sure to download our eBook to learn more about how to treat the different stages of hypertension and the benefits automated solutions can provide in detecting, diagnosing and managing this condition inside the clinic and beyond.

References:

1. American Heart Association. 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults.

2. American Heart Association and American Stroke Association. 2017 Heart Disease and Stroke Statistics Update.

3. Whelton PK, Appel LJ, Espeland MA, et al; for the TONE Collaborative Research Group. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA. 1998;279(11):839-846.

4. Whelton PK. The elusiveness of population-wide high blood pressure control. Annu Rev Public Health. 2015;36:109-130.

5. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1974;268(6):336-345.

6. National Heart, Lung, and Blood Institute. High Blood Pressure. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure. Accessed September 17, 2018