The U.S. National Institutes
of Health publishes guidelines for doctors on high blood pressure classification and treatment. The guidelines are called the Seventh Report of the Joint National
Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High
If you have high blood pressure, your doctor will give you a blood pressure goal that is based on your health. For example, your goal will depend on whether you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease.
Be sure you know your blood pressure goal.
Blood pressure of 120–139 over 80–89
High blood pressure of 140–159 over 90–99
Lifestyle changes, possibly
High blood pressure of 160 over 100 or
Medicines plus lifestyle
High blood pressure plus organ damage or
other risk factors for heart disease
Medicines plus serious lifestyle changes
and treatment for the other health problems
Secondary high blood pressure
Medicines, treatment of the condition
causing your high blood pressure, or both
African Americans are more likely to develop
high blood pressure and often have more severe high
blood pressure than other groups. They also are more likely to have the
condition at an earlier age than others. It is not known why they are at
African Americans who are sensitive to salt (sodium), who are obese, or who smoke are at even higher risk
for high blood pressure. As a result, African Americans with these risk factors tend to have more organ damage, such as kidney disease, heart
attack, and enlargement of the heart, which can lead to
heart failure (hypertensive heart disease). Lifestyle
changes are especially important for this group.
Children who have
high blood pressure often continue to have high blood
pressure as adults. Children ages 3 and older need to have their blood pressure
monitored regularly during routine physical exams.
pressure in children is rare but needs to be evaluated to find treatable
causes. When a child has high blood pressure, it is more likely to be from a
secondary cause—like a disease—than when an adult has high blood
High blood pressure in children should be treated with
lifestyle changes and medicine if needed. A child with secondary high blood
pressure also requires medicine. The risk of secondary high blood pressure is
higher in children than in adults.
Older adults often have isolated
systolic high blood pressure. This problem
is sometimes called ISH, for isolated systolic hypertension. In
ISH, systolic blood pressure is above 140, but diastolic blood pressure stays
lower than 90.
If you are older than 50, a
systolic blood pressure (the upper number) over 140 is a
more important risk factor for stroke and heart disease than your diastolic
blood pressure (the lower number).
This type of
high blood pressure is more common in older adults,
especially older women. In fact, most people older than 60
who have high blood pressure have ISH.
should be treated, because it can damage organs such as the brain, kidneys,
heart, and eyes.
Lifestyle changes might be enough to lower blood pressure. These changes include eating healthy with the DASH diet, losing weight, being active, limiting sodium, and limiting alcohol.
Your doctor may have you take a high blood pressure medicine such as a diuretic.
One problem with
treating ISH is that some high blood pressure medicines can cause blood
pressure to go too low, causing side effects like lightheadedness or
a slow heartbeat. And older people are more
likely to get these side effects. That's why it's important to monitor your blood pressure and to let your doctor know if you feel dizzy, lightheaded, or faint.
If you have a blood pressure of 120 to 139
systolic (the upper number in a blood pressure measurement) over 80 to 89
diastolic (lower number), you have prehypertension. This is blood
pressure that is higher than normal but not high enough to be high blood
pressure. It is a warning that your blood pressure is going up. You
need to begin lifestyle changes to lower your risk for stroke, heart disease,
and other problems caused by high blood pressure.
For more information, see the topic Prehypertension.
Secondary high blood pressure treatment depends
on the cause. For example, treatment of high blood pressure caused
by kidney disease will also include treating the kidney problem. Even if the
condition that caused your high blood pressure is treated,
you may still have to take blood pressure medicine throughout your
For more information, see the topic Secondary High Blood Pressure.
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.
Other Works Consulted
Aronow WS, et al. (2011). ACCF/AHA 2011 Expert consensus document on hypertension in the elderly: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation, 123(21): 2434–2506.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
April 5, 2013
E. Gregory Thompson, MD - Internal Medicine
& Robert A. Kloner, MD, PhD - Cardiology
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