Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

The American Heart Association released an updated hypertension guideline in both 2017 and 2019 that discussed updated blood pressure targets and treatment recommendations for patients with high blood pressure.

In the hypertension guidelines, 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.¹The updated guidelines define stage 1 hypertension as 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

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 measurements are encouraged to continue leading a healthy lifestyle to maintain their normal BP and prevent the development of hypertension. Patients with normal BP measurements can be evaluated annually.

Elevated Blood Pressure

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 Recommendation for strategies to promote lifestyle modification: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%:

If the patient's ASCVD risk is less than 10% then their lifestyle changes should be managed with nonpharmacological therapies. The patient’s BP level should be assessed in 3-6 months.¹

ASCVD greater than 10%:

Use of BP-lowering medications is recommended for primary prevention in adults with an estimated ASCVID risk of 10% or higher. 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 Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in 1 month.¹ If a 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

Key Takeaway

There is a graded association 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

Learn more about managing hypertension at hillrom.com/hypertension.

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.

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US-FLC45-250026 (v1.0) 05/2025