Hypertension Management Guidelines

Blood Pressure Classification and Measurement

The American College of Cardiology defines hypertension stages as: Normal (<120/<80 mm Hg), Elevated (120-129/<80 mm Hg), Stage 1 Hypertension (130-139/80-89 mm Hg), and Stage 2 Hypertension (≥140/≥90 mm Hg) 1
The American College of Cardiology recommends classifying patients by the higher category when systolic and diastolic readings fall into different categories 1
Diagnosis of hypertension requires an average of ≥2 properly measured readings on ≥2 separate occasions, according to the American College of Cardiology 1

For patients with Stage 1 Hypertension, the American Heart Association recommends lifestyle modifications alone initially, with initiation of drug therapy only if BP remains ≥140/90 mm Hg after 3-6 months of lifestyle intervention 5, 3
For high-risk patients with Stage 1 Hypertension, the American College of Cardiology recommends starting lifestyle modifications PLUS single antihypertensive agent 5, 3
For patients with Stage 2 Hypertension, the American College of Cardiology recommends immediately initiating both nonpharmacologic therapy AND antihypertensive medications, with a target BP of <130/80 mm Hg 5, 2

The American College of Cardiology recommends a target BP of <130/80 mm Hg for most patients, with a minimum acceptable control of <150/90 mm Hg 5, 3
For patients ≥65 years, the American College of Cardiology recommends a target systolic BP of <130 mm Hg, with no specific diastolic target recommended 5
The American College of Cardiology recommends reassessing patients with Stage 2 Hypertension in 1 month after initiating treatment, and patients with Stage 1 Hypertension in 1-2 months if on medication, or 3-6 months if on lifestyle modifications only 2, 3