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What are the stages of hypertension?

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Normal levelsPrehypertensive levelsStage 1 hypertensionStage 2 hypertensionHypertensive crisisMedication optionsSummary
Hypertension is a common health condition that can happen when the pressure of blood against your artery walls is too high. The condition can often occur in several different stages.
Medically reviewed by Megan Soliman, MD
Written by D. M. Pollock
Updated on February 23, 2024

Hypertension, also known as high blood pressure, is a common condition that can develop due to several factors, including your age and diet.

To measure your blood pressure, a doctor will take readings of the following measures. These are:

  • Systolic blood pressure: This is the reading of blood pressure against your arteries as your heart is contracting and is the first, higher number of the two readings.
  • Diastolic blood pressure: This is the reading of blood pressure against your arteries during the relaxation of your heart muscle and is the second reading.

Your blood pressure will rise and fall throughout the day. However, if your blood pressure stays high for a long time, it can lead to health issues and damage your blood vessels.

As of 2017, the American Heart Association (AHA) changed the definitions and guidelines of hypertension stages. If your systolic blood pressure measures between 120 and 129 millimeters of mercury (mmHg), a doctor will consider it high.

1. Normal levels

Older adult sat on a bed checking his blood pressure via an at home monitor.
OLEKSANDRA TROIAN/Getty Images

Normal blood pressure is the term healthcare professionals use when you have no sign of hypertension. Blood pressure readings of less than 120 mmHg and 80 mmHg are considered within the normal range.

If your blood pressure readings fall within this category, it often means your diet and lifestyle habits are heart-healthy.

While numbers less than 120/80 are considered normal, blood pressure can also be too low. A reading of 90/60 and below is considered hypotension or low blood pressure.

Continuing to follow a healthy diet low in saturated fats and getting regular aerobic exercise will help maintain a healthy blood pressure.

2. Prehypertensive levels

Prehypertension is the slight elevation of your blood pressure to just above healthy and normal levels. However, it is still not hypertensive.

If your blood pressure readings are between 120 and 129 mmHg systolic, and less than 80 mmHg diastolic, for example, 125/ 79 mmHg, a healthcare professional will likely diagnose you with prehypertension.

Receiving a diagnosis of prehypertension can be helpful as it allows for early intervention to prevent you from developing hypertension and other complications.

The best way to do this is by modifying your lifestyle. Some lifestyle choices that a doctor may recommend to help lower your blood pressure if you are prehypertensive include:

  • learning to manage stress
  • doing aerobic exercise, such as jogging and cycling
  • reducing the amount of saturated fat in your diet
  • consuming more fresh fruit and vegetables
  • limiting how much alcohol you consume (if you drink)
  • increasing your consumption of grains such as quinoa
  • lowering your salt intake  
  • stopping smoking, if you smoke

3. Stage 1 hypertension

According to the AHA’s 2017 guidelines for hypertension diagnosis, stage 1 hypertension is a reading of 130–139 mmHg systolic blood pressure or 80–89 mmHg diastolic.

These readings are now lower than they were previously, meaning more people will receive a diagnosis of hypertension than before the guidelines changed.

If you receive a diagnosis of stage 1 hypertension, a doctor will likely recommend a combination of lifestyle changes and potential medications. Whether you receive prescription medications to manage your blood pressure will depend on your medical history and how high your blood pressure readings are within the stage 1 readings.

Stage 1 hypertension can increase your chance of developing a cardiovascular disease within 10 years, and this increases further if you go on to develop stage 2. Receiving an early diagnosis of stage 1 and sticking to your treatment plan will help to reduce this risk.

Treating stage 1 blood pressure can significantly reduce your chance of developing and experiencing serious complications, such as stroke and kidney disease, and death.

4. Stage 2 hypertension

Stage 2 hypertension is consistently high blood pressure readings of above 140/90 mmHg. If you receive a diagnosis of stage 2 hypertension, a doctor will usually recommend medication or a combination of medications and lifestyle measures.

A healthcare professional will continually monitor your blood pressure and track the progress of your treatment regimen. If it is not as effective as it needs to be, they can alter your treatment plan.

5. Hypertensive crisis

A hypertensive crisis is a sudden and large increase in your blood pressure to 180/120 mmHg or higher. This is a medical emergency.

Extremely high blood pressure can quickly lead to severe symptoms such as:

There are two types of hypertensive crisis. They both require immediate medical attention to avoid complications.

The two types are:

  1. Hypertensive urgency: This is where your blood pressure reading is 180/120 mmHg or higher, but you are not noticing any of the above severe symptoms. This typically means a doctor needs to adjust your medication dose.
  2. Hypertensive emergency: This is where your blood pressure reading is 180/120 mmHg or higher, and you are experiencing one or more of the above severe symptoms.

You may also notice:

  • shortness of breath
  • chest pain
  • numbness
  • change to your vision
  • difficulty speaking

If you experience these signs, you need to call 911 immediately as you will require close monitoring and, in some instances, intravenous medications with hospitalization.

Medication options for hypertension

If you have a diagnosis of high blood pressure, a doctor will likely recommend a combination of lifestyle modifications and medications to help lower your levels. The type of medications a doctor prescribes will depend on your individual needs and lifestyle requirements.

Common types of blood pressure medications include:

  • Diuretics: These medications help rid your body of excess water and salt to lower blood pressure. Some common brand names include Lozol and Hygroton.
  • Beta-blockers: These medications help lower blood pressure by slowing your heart rate. This helps decrease the output of blood from the heart with each pump. Examples include atenolol (Tenormin) and bisoprolol (Zebeta).
  • Calcium channel blockers: This group of medications helps relax your blood vessels, slow your heart rate, and lower blood pressure by preventing calcium from entering your arteries and heart. A common example is diltiazem (Cardizem).
  • Alpha-blockers: These medications help lower blood pressure by reducing the stiffness of your arteries. Examples include doxazosin (Cardura) and terazosin (Hytrin).

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Summary

Hypertension is the elevated pressure of your blood against your arteries. Several different stages of high blood pressure exist, including:

  1. prehypertension
  2. stage 1 hypertension
  3. stage 2 hypertension
  4. hypertensive crisis

You can manage high blood pressure with medications and lifestyle measures to help lower and prevent the risk of serious complications like stroke and heart disease.

The type of medication a doctor will prescribe you will depend on the stage of your hypertension and how you respond to a treatment regimen.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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