Understanding The Four Stages Of Hypertension

Hypertension, more commonly known as high blood pressure, is considered a silent killer. In many cases, it does not have any symptoms and is only discovered during routine medical screenings.

The four categories of blood pressure refer to how high your blood pressure is, which affects the treatment you need. While high blood pressure does tend to worsen over time, it can also jump straight to the dangerous stage of hypertensive crisis in some cases. Even in situations like this, you may still show no symptoms.

The four blood pressure categories are potentially progressive. If elevated blood pressure levels are not treated, you will likely move into a higher category over time. However, this is not always the case.

Proper management can generally slow the rise of blood pressure and even bring it back down to a normal range. However, blood pressure will generally rise again if you stop taking your medications or go back on your lifestyle changes.

In 2017, the American College of Cardiology and the American Heart Association released new guidelines for blood pressure categories. There are four stages: normal, elevated (not officially considered hypertension), stage I hypertension, and stage II hypertension.  

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1. Normal blood pressure

Normal blood pressure is below 120/80mm Hg. The number at the top is systolic pressure, which measures the pressure in the blood vessels when your heart beats. The bottom number, the diastolic pressure, is the pressure in the blood vessels while the heart is relaxed.

Blood pressure is measured in millimeters of mercury (mm Hg) units. It is possible to have normal diastolic pressure and high systolic pressure. This is relatively common in older adults and is called isolated systolic hypertension. It is also sometimes called “elevated” blood pressure.

Isolated systolic hypertension is caused by your arteries stiffening up as you age, and it can cause symptoms such as fainting and shortness of breath after even minor exercise. Once you reach 50, you should have a routine check-up.

It is also possible to have blood pressure that is too low, known as hypotension. Hypotension can cause fatigue,  fainting, and dizziness and can be a result of dehydration.

Repeated symptoms of low blood pressure can indicate a more serious problem, such as heart problems or a severe infection. It can also be a side effect of medications.

Low blood pressure can occur during pregnancy and be the cause of the mother fainting during the first trimester, and this should be checked out by a doctor. Low blood pressure is considered a problem if systolic blood pressure is below 90 and/or diastolic is below 60mm Hg.

Some people have naturally higher or lower blood pressure than others. If you have consistently low blood pressure, your doctor may recommend you drink more water, use more salt, reduce your consumption of alcohol, or take medications.

Having regular screenings will help you and your doctor learn what is normal for you regarding blood pressure.

Screening is particularly important for pregnant women, African Americans, and people with a family history of high blood pressure, especially if it is not associated with another condition or disease. However, everyone should check their blood pressure at least once a year and then recheck if the reading is unusually high.

2. Elevated blood pressure

Elevated blood pressure is defined as systolic pressure between 120 and 129mm Hg and diastolic pressure less than 80mm Hg. More recent studies have shown that even this level of blood pressure elevation can cause problems.

Elevated blood pressure is a more accurate term because it is very likely to progress to full-blown hypertension if you don’t take steps to moderate it. Typically, if your doctor tells you that you have elevated blood pressure, they will recommend lifestyle changes to get your blood pressure under control before it becomes worse.

Elevated blood pressure already carries with it an increased risk of heart disease and stroke, so it’s important to take steps to get things under control. It is also possible to delay taking medications, perhaps indefinitely. Blood pressure medication has some side effects, so controlling your blood pressure with lifestyle changes is always the preferred option.

However, if you also have diabetes or kidney disease, your doctor may prescribe medications to reduce your risk of future medical issues. If you are pregnant, you will be monitored for potential complications. Higher than normal blood pressure in pregnancy can quickly progress to a potentially life-threatening situation.

Here are the lifestyle changes that are recommended and proven in clinical trials for elevated blood pressure:

  1. Adopting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which involves increasing fruits and vegetables and reducing fat

  2. Losing weight, which is effective even if you can’t attain or sustain “normal” body mass index

  3. Reducing sodium intake to less than 2400mg/day. This involves watching for hidden salt in many common foods, especially processed and fast foods.

  4. Increasing physical activity to about 30 minutes of moderate exercise most days

  5. Moderating alcohol intake

Most of these changes will help your overall health as well. Regular screening can help detect prehypertension so that you can take steps to lower your blood pressure before it reaches levels at which you need medication.

Screenings can prevent irreversible organ damage, which can be caused by long-term, untreated hypertension. Your doctor might also recommend therapy to help get and keep your stress levels under control.

Bear in mind that everyone’s blood pressure varies over time. Diagnosis of high blood pressure requires multiple readings at different times, and many doctors now use home monitoring. It records blood pressure over 24 hours to eliminate issues such as white coat syndrome (when your blood pressure is high in the doctor’s office due to anxiety) and other transitory spikes.

Blood pressure can also be temporarily spiked by situations that invoke anxiety or anger, caffeine in individuals who are sensitive to it, and certain foods, including black licorice.

3. Stage I hypertension

When you have a blood pressure reading of 130–139mm Hg systolic or 80–89mm Hg diastolic, this stage is officially called hypertension. Most doctors will start considering medication, although it’s normal to try lifestyle changes first as there is still a chance they can work or help your medication work better.

Regardless of what medicine you might be prescribed, it is still essential to eat a healthy diet, exercise, and reduce sodium intake. You may be asked to cut out alcohol altogether due to medication interaction.

Home blood pressure monitoring should be used to establish whether your medication is working and your dosage is optimum. Medication can usually improve your blood pressure quickly, but it is vital to keep taking it as instructed.

The higher your blood pressure, the higher the risk of organ damage or heart disease. You may need more than one medication to meet the blood pressure target your doctor has set for you.

High blood pressure cannot be cured, but you can manage it, and any progression can be slowed. Unfortunately, 40% of the people with high blood pressure don’t have it under control, and many don’t even know they have it. It can be particularly challenging to manage a condition with no obvious symptoms.

Stage I hypertension carries an increased risk of disease but may display no symptoms until it has been running high for a while. However, blood pressure will rise over time if not brought under control.

4. Stage II hypertension

Not all doctors make a distinction between stage I and stage II hypertension, but the typical definition is a systolic pressure of 140mm Hg or higher or a diastolic pressure of 90mm Hg or higher. Again, the higher your blood pressure, the higher your risk for medical problems.

Severe hypertension often happens when high blood pressure goes undiagnosed and so is more common in populations that don’t or can’t get routine medical care. Typically, your blood pressure does not jump to this level suddenly, although acute crises can and do occur.

It’s essential to avoid severe hypertension. High blood pressure can shorten your lifespan. One study indicated that men without high blood pressure lived about 7.2 years longer¹ without developing cardiovascular disease. It also showed an overall lifespan decrease of 5.1 years for men and 4.9 for women.

An important thing to note is that high blood pressure is more likely to be diagnosed quickly in people who look after their health. However, it is still clear that there are direct correlations between high blood pressure and damage to various organs, including the heart, kidney, and eyes.

While high blood pressure can be brought down to normal, its damage may be permanent, resulting in an ongoing elevated risk that could have been avoided through screening and early treatment.

The treatment for stage II hypertension is the same as for stage I, although your doctor may be more likely to prescribe multiple medications to quickly get your blood pressure down before further damage is done to your body. As organ damage may not be reversible, your doctor will discuss the importance of complying with your treatment program.

The consequences of uncontrolled high blood pressure include:

  1. High risk of stroke

  2. Increased risk of heart attack

  3. Peripheral vascular disease², also known as atherosclerosis

  4. Vascular dementia³ caused by issues with blood flow in the brain and can cause permanent cognitive loss

  5. Eye damage

  6. Pregnancy complications

High blood pressure can damage nerves in the retina⁴, affecting your retina’s ability to translate light into nerve signals. This is called hypertensive retinopathy, and it seldom has symptoms until it has progressed.

You might experience double vision, dimming of your vision, vision loss, and headaches caused by eye strain. This damage can be permanent.

Pregnancy complications can also be severe. Preeclampsia is caused by high blood pressure during pregnancy and can result in premature delivery. It can threaten the life of both the pregnant patient and the fetus.

Hypertension also increases your risk of heart disease, cerebrovascular disease, and stroke. The higher your blood pressure, the higher the risk of these problems occurring. Many people do not have their blood pressure under control, and some may not know they have a problem until serious damage has been done.

The lowdown

The higher the blood pressure stage, the higher risks it poses to your health. Make sure to get your high blood pressure under control with lifestyle changes as soon as you know you’re in the prehypertension range.

While high blood pressure cannot be cured, it can be controlled with proper treatment. This can keep you from developing serious medical issues, such as heart attack and stroke, and extend your life.

Be proactive by having your blood pressure checked regularly so that you don’t unexpectedly end up with severe hypertension and all of its problems. The earlier you catch elevated blood pressure, the easier it will be to treat.

Have you considered clinical trials for High blood pressure?

We make it easy for you to participate in a clinical trial for High blood pressure, and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
Peter, 64


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