- Prehypertension falls in the range between normal blood pressure and stage 1 hypertension.
- Stage 1 hypertension is a systolic of 140 to 159 mmHg or diastolic of 90-99 mmHg.
- Stage 2 hypertension is a systolic of 160 mmHg or higher, or a diastolic of 100 mmHg or higher.
- Isolated systolic hypertension is a systolic blood pressure or 140 mmHg or higher but with a diastolic blood pressure in normal or prehypertension range.
- Isolated diastolic hypertension is a diastolic blood pressure of 90 mmHg or higher but with a systolic blood pressure in normal or prehypertension range.
- Hypertensive urgency is a diastolic blood pressure of 120 mmHg or higher which is not causing any symptoms or damage to organs.
- Malignant hypertension is characterized by a diastolic blood pressure over 100 mmHg with visual changes or altered mental status. The patient may have swelling of the optic disc from elevated intracranial pressure, retinal hemorrhage, or hypertension related encephalopathy.
- Again, consult a physician immediately for hypertensive urgency, malignant hypertension, or hypotension.
Diagnosis of hypertension at home:
Hypertension is diagnosed by the following criteria at home using a home blood pressure monitor:
- Average blood pressure elevation of 135/85 mm Hg over 24 hours.
- Average blood pressure while asleep overnight over 125/75 mmHg.
- Average blood pressure during the day over 140/90 mmHg while awake.
JNC 7 recommendations for hypertension:
Recommendations of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) (4) include 1) reduce sodium (salt) consumption to less than 2.4 g/day. 2) Exercise at least 30 min/day, 4 days per week. 3) Consume no more than 2 alcoholic drinks per day for men and 1 drink or less per day for women. 4) Eat a diet rich in fruits, vegetables, potassium, calcium, magnesium and low in fat and salt. 5) A weight loss goal of 10 lb or 4.5 kg is recommended.
New HTN Guidelines: Eighth Joint National Committee (JNC 8) for Use of Medication as of Feb of 2014
Based on new research, JNC 8 advised healthcare providers to use HTN medication less aggressively. This allows patients more flexibility in adopting lifestyle changes, weight loss and supplements to reduce the potential need for BP medication. JNC 8 advised medication for a systolic BP over 140 or diastolic BP over 90 in patients < 60 years of age, or for any age patient with diabetes or chronic kidney disease. For patients > 60 years of age, JNC advised medication for a systolic BP over 150 or diastolic BP over 90 in patients > 60 years old. (95)