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Hypertension (high blood pressure) affects roughly one-third of the US adult population. As a risk factor that lifestyle choices can influence, only cigarette smoking causes more cardiovascular deaths in the United States. Understanding the stages of blood pressure and the lifestyle changes you can make to lower your blood pressure can help decrease your risk, putting you on the path to better health.   

Blood pressure is a measure of the pressure exerted by circulating blood on the walls of arteries, similar to how water exerts pressure on the walls of a hose. The systolic pressure is measured when the heart’s lower chambers contract and push blood into the circulation. The diastolic pressure is the number recorded when the heart relaxes. A blood pressure cuff is used to measure blood pressure by inflating and slowly deflating the cuff, causing turbulence in the blood flow. 

What is hypertension?

Hypertension is diagnosed when your blood pressure is above the normal range. When your blood pressure is too high, it puts stress on the blood vessels, increasing the chances of having a heart attack, stroke, or kidney disease. Unfortunately, high blood pressure rarely results in symptoms. With no warning symptoms, it is crucial to be proactive.  

Because blood pressure can fluctuate, your doctor may ask you to take several measurements at home during different times of the day before diagnosing hypertension. In addition, many people have high blood pressure when visiting a doctor’s office, a phenomenon known as white coat syndrome, making it even more important to track your blood pressure readings over time to understand your normal blood pressure.  

What are the stages of hypertension? 

Because blood pressure is a continuous measurement, it is divided into stages. Your suggested treatment options will be influenced by where your blood pressure falls in these intervals. 

Normal Blood Pressure 

Normal blood pressure is defined as systolic blood pressure below 120 mmHg (millimeters of mercury) and diastolic blood pressure below 80 mmHg.  

Elevated  

If your systolic blood pressure reading is between 120-129 mmHg and your diastolic pressure stays below 80 mmHg, you meet the criteria for elevated blood pressure or prehypertension.  

Stage 1 Hypertension 

When systolic blood pressure ranges from 130-139 mmHg, and diastolic is between 80 and 89 mmHg, it meets the criteria for stage 1 hypertension. At this stage, the Eighth Joint National Committee (JNC8) recommends making lifestyle changes to reduce blood pressure. If you are at higher risk for cardiovascular disease, your doctor may also prescribe medications.  

Stage 2 Hypertension 

When blood pressure consistently measures over 140 mmHg systolic and 90 mmHg diastolic or higher, it meets the criteria for stage 2 hypertension. A combination of lifestyle changes and medications may be necessary to reduce blood pressure to the normal range.  

Hypertensive Crisis 

A hypertensive crisis is a dangerously high blood pressure that necessitates immediate medical attention. A hypertensive crisis is defined as having systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg, which may also present with additional symptoms such as dizziness, confusion, and/or shortness of breath. At this point, the patient should call 911 or proceed to the nearest emergency room. 

 

Blood Pressure Stages 
Blood Pressure Status  Systolic  Diastolic 
Normal  Less than 120  Less than 80 
Elevated  120-129 and  Less than 80 
Hypertension Stage 1  130-139 or   80-89 
Hypertension Stage 2  140 or higher or  90 or higher 
Hypertension Crisis  180 or higher and/or  Higher than 120 

According to the American Heart Association 

What lifestyle changes can I make to lower my blood pressure?

Whether you have been diagnosed with hypertension or want to make lifestyle changes to decrease your risk, making changes now can result in years of future good health. If lifestyle changes do not bring your blood pressure down to the appropriate level, your doctor may prescribe medication. Clinical trials have shown that the following lifestyle changes can lower blood pressure: 

Avoid adding salt to food 

Salt (sodium chloride) is essential for many bodily processes. Water usually follows sodium, which helps control pressure and volume in your body cells and blood vessels. When there is too much sodium in the blood, it draws more water into the bloodstream, increasing blood volume and, as a result, blood pressure. Some people are more sodium sensitive than others. 

Reduce your sodium intake to less than or equal to 2400 mg sodium, optimally less than 1500 mg/day, which is roughly 2/3-1 teaspoon of salt. Processed foods contain large amounts of sodium. You can reduce your sodium intake by increasing the amount of unprocessed foods in your diet and refraining from using salt at the table. 

Consume a DASH Diet 

The DASH Diet stands for dietary approaches to stop hypertension. A DASH eating plan emphasizes a diet high in fruits, vegetables, and whole grains. Include low-fat or no-fat dairy products, fish, poultry, nuts, beans, and vegetable oils in your diet as well. Minimize your consumption of foods high in saturated fats, such as fatty meats, full-fat dairy products, and tropical oils. Four to five servings of fruits and vegetables should provide 1500 to 3000 mg of potassium. If your diet is high in sodium, eating more potassium-rich foods can help lower your blood pressure. Clinical studies have shown that following a DASH diet can lower your systolic blood pressure by 8-14 mmHg and decrease LDL cholesterol (bad cholesterol).  

Stop Tobacco Use 

Nicotine narrows and stiffens your blood vessels, which increases blood pressure and makes your heart work harder. To visualize this, consider the pressure changes when water goes from a large hose to one that is half its diameter. Smoking increases blood pressure even in young people diagnosed with stage 1 hypertension.  

Reduce Your Stress 

Stress activates the sympathetic nervous system, also known as the “fight-or-flight nervous system,” and increases the release of cortisol, commonly referred to as stress hormone. Stress does not directly cause hypertension, but it can affect how quickly it develops.  

Try these steps to reduce stress:  

  • Meditate
  • Exercise
  • Get adequate sleep 
  • Light a candle or use essential oils 
  • Reduce caffeine intake
  • Play with a pet 
  • Spend time with people you care about 
  • Make time for favorite activities 
  • Journal 
  • Ask for help when needed  
  • Say no when necessary 

What’s Next? 

Because it does not cause symptoms, hypertension can be a difficult disorder to manage. Knowing that your blood pressure is elevated or has the potential to be is an excellent first step towards regaining control of your health.  

Checking and tracking your blood pressure can provide personalized feedback on your progress. The first step to improving your cardiovascular health is making potential lifestyle changes to decrease your blood pressure.  

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Leann Poston, MD, is a licensed physician in Ohio who holds an MBA and an M.Ed. She is a full-time medical communications writer and educator who researches and writes about medicine, education, and healthcare administration. 

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