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Definition and Treatment of High Blood Pressure

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Table 1. Definition and Treatment of High Blood Pressure

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Blood Pressure (mmHg)ClassificationTreatment (associated tables in bold)
* Comorbidities include diabetes, CAD, peripheral vascular disease, cerebrovascular disease, heart failure, or renal disease defined as a reduced GFR (CrCl <60 mL/min/1.75 m2) or albuminuria (>300 mg/dL).
# The JNC 7 Report recommends a target BP of <130/80 for patients with diabetes or CKD. AHA 2007 guidelines also recommend a target BP of <130/80 for patients withknown CAD, or CAD equivalents (carotid or peripheral arterial disease, abdominal aortic aneurysm), or 10-year Framingham Risk Score ≥10%.

Adapted from VA/DoD Clinical Practice Guideline Working Group. Management of Hypertension in Primary Care. Washington, D.C.: Department of Veterans Affairs, Office of Quality and Performance; 2004.

Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 reportLink will take you outside the VA website.. JAMA. 2003 May 21;289(19):2560-72.

Rosendorff C, Black HR, Cannon CP, et al. Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and PreventionLink will take you outside the VA website.. Circulation. 2007 May 29;115(21):2761-88.
<120/80Normal
  • No treatment indicated.
  • Encourage lifestyle measures as shown under Management.
  • Systolic: 120-139
  • or
  • Diastolic: 80-89
Prehypertension
  • Lifestyle modification and
  • Treat comorbidity,* if present and appropriate.
  • If diabetic, treat to target BP of <140/80.#§
  • Systolic: 140-159
  • or
  • Diastolic: 90-99
Stage 1 hypertension
  • Goal: BP <140/90 (140/80 if diabetic)#§
  • Lifestyle modification and
  • Start medication
    • If no comorbidity,* use thiazide (preferred) or angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB), calcium channel blocker (CCB), or fixed-dose combination (FDC) of agents.
    • If comorbidity,* choose from table of disease-specific antihypertensives.
  • Systolic: >159
  • or
  • Diastolic: >99
Stage 2 hypertension
  • Goal: BP <140/90 (140/80 if diabetic)#§
  • Lifestyle modification and
  • Start 2 medications
    • If no comorbidity,* use thiazide plus ACEI, ARB, BB, or CCB, dosed separately or as an FDC.
    • If comorbidity,* choose from table of disease-specific antihypertensives.
  • Consider gradual BP reduction starting with 1 agent for patients at risk of postural hypotension (eg, elderly).

From Hypertension
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009