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Types and stages of hypertension
Hypertension is the medical term for high blood pressure. The definition of high blood pressure changed in 2017, when the American College of Cardiology and the American Heart Association revised their hypertension guidelines.
A blood pressure between 120 and 129 mm Hg for the top (systolic) number and more than 80 mm Hg (diastolic) for the bottom number is considered elevated.
The 2017 guidelines don’t recommend starting medication at the elevated stage unless you have high risk factors. Instead, they recommend implementing lifestyle changes.
Read on to learn about the different types of hypertension and what you can do to manage high blood pressure.
Under the new 2017 guidelines, all blood pressure measurements over 120/80 mm Hg are considered elevated.
Now blood pressure measurements are categorized as follows:
- Normal: systolic less than 120 mm Hg and diastolic less than 80 mm Hg
- Elevated: systolic between 120-129 mm Hg and diastolic less than 80 mm Hg
- Stage 1: systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg
- Stage 2: systolic at least 140 mm Hg or diastolic at least 90 mm Hg
The new classification system puts more people into the elevated category who were previously considered prehypertensive.
Under the new guidelines,an estimated 46 percent of U.S. adults became categorized as having high blood pressure.
Treatment is recommended at the elevated stage if you have heart disease or other risk factors, such as diabetes and family health history.
If your blood pressure reading is in the elevated category, discuss with your doctor what steps you can take to lower it.
Primary vs. secondary hypertension
Primary hypertension is also known as essential hypertension. Most adults with hypertension are in this category.
Despite years of research on hypertension, a specific cause isn’t known. It’s thought to be a combination of genetics, diet, lifestyle, and age.
Lifestyle factors include smoking, drinking too much alcohol, stress, being overweight, eating too much salt, and not getting enough exercise.
Changes in your diet and lifestyle can lower your blood pressure and risk of complications from hypertension.
Secondary hypertension is when there’s an identifiable— and potentially reversible— cause of your hypertension.
Only about 5 to 10 percent of hypertension is the secondary type.
It’s more prevalent in younger people. An estimated 30 percent of those ages 18 to 40 with hypertension have secondary hypertension.
The underlying causes of secondary hypertension include:
- narrowing of the arteries that supply blood to your kidneys
- adrenal gland disease
- side effects of somemedications, including birth control pills, diet aids, stimulants, antidepressants, and some over-the-counter medications
- obstructive sleep apnea
- hormone abnormalities
- thyroid abnormalities
- constriction of the aorta
Other types of hypertension
Subtypes that fit within the categories of primary or secondary hypertension include:
- resistant hypertension
- malignant hypertension
- isolated hypertension
Resistant hypertension is the name given to high blood pressure that’s difficult to control and requires multiple medications.
Hypertension is considered resistant when your blood pressure stays above your treatment target, even though you’re taking three different types of blood pressure lowering medications, including a diuretic.
An estimated 10 percent of people with high blood pressure have resistant hypertension.
People with resistant hypertension may have secondary hypertension where the cause hasn’t yet been identified, prompting a search by their doctor for secondary causes.
Most people with resistant hypertension can be successfully treated with multiple drugs or with the identification of a secondary cause.
Malignant hypertension is the term used to describe high blood pressure that causes damage to your organs. This is an emergency condition.
Malignant hypertension is the most severe type, characterized by elevated blood pressure usually at >180 mm Hg systolic or >120-130 mm Hg diastolic, plus damage to multiple organs.
The prevalence of malignant hypertension is low — about 1 to 2 cases in 100,000. Rates may be higher in populations of black people.
Malignant hypertension is an emergency medical condition and requires quick treatment. Seek immediate emergency medical attention if you think you may be having a hypertensive emergency.
Isolated systolic hypertension
Isolated systolic hypertension is defined as systolic blood pressure above 140 mm Hg and diastolic blood pressure under 90 mm Hg.
It’s the most frequent type of hypertension in older adults. An estimated 15 percent of people 60 years or older have isolated systolic hypertension.
The cause is thought to be the stiffening of arteries with age.
Younger people can also develop isolated systolic hypertension. A 2016 study noted that isolated systolic hypertension appears in 2 percent to 8 percent of younger people. It’s the most common form of hypertension in youth ages 17 to 27, according to a United Kingdom survey.
A large study published in 2015 with an average of 31 years follow-up found that younger and middle-aged people with isolated systolic hypertension were at a higher risk of stroke and heart attack compared with those with normal blood pressures.
A hypertensive emergency, also called malignant hypertension, is when your blood pressure suddenly rises above 180/120 and you have symptoms from this sudden increase in blood pressure. These include:
- chest pain
- shortness of breath
- visual changes
This is a life threatening condition, because high blood pressure can damage essential organs or cause complications such as an aortic dissection or tear or bleeding in the brain.
Seek immediate emergency medical attention if you think you may be having a hypertensive emergency.
Only 1 to 3 percent of people with hypertension are likely to have a hypertensive emergency during their lifetime. Be sure to take your prescribed blood pressure medications avoid drugs that stimulate your nervous system, as these are common causes of hypertensive emergency.
Hypertensive urgency is when your blood pressure is above 180/120, but you have no other symptoms.
Hypertensive urgency is most often treated by adjusting your medications. It’s important to treat hypertensive urgency quickly so it doesn’t become a hypertensive emergency.
Although fewer than 1 percent of people with hypertensive urgency are referred to a hospital, and few of these suffer adverse effects, it’s a still a serious condition and you should call your doctor’s office immediately or seek medical care if you have hypertensive urgency.
White coat hypertension
This term refers to when your blood pressure may go up temporarily simply because you’re in a doctor’s office or another stressful occurrence, like being stuck in traffic.
Previously, this condition was found to be benign. More recently, it’s been associated with increased cardiovascular risk. Often, people with white coat hypertension will progress to having a diagnosis of hypertension.
Usually before you’re started on a medication for hypertension, your doctor will monitor your blood pressure over a period of time in different settings. Your diagnosis won’t be based on one reading but any reading out of range should be discussed with your doctor.
Hypertension treatment and management
The good news about high blood pressure is that you can prevent and manage it.
Keep track of your blood pressure
A first step is to regularly monitor your blood pressure if you’re at risk. Your doctor can do this in the office or you can do it at home with a blood pressure monitoring kit.
If you’re taking blood pressure medications or other measures, you’ll be able to see if they have an effect.
Measuring blood pressure
When your heart beats, it creates pressure that pushes blood throughout your circulatory system. Your blood pressure is measured with two numbers, in units of millimeters of mercury (mm Hg).
- The first (top) number represents the pressure when your blood is pumped from your heart to your arteries. This is called systolic blood pressure.
- The second (bottom) number represents the pressure when your heart is at rest, between beats. This is called diastolic blood pressure.
Consider making lifestyle changes to prevent hypertension or to keep your hypertension in check. In particular, exercise can be very effective in lowering your blood pressure.
Here are other changes that can help:
- not smoking
- eating a healthy diet
- cutting back on sugar and carbohydrates
- not drinking alcohol or drinking in moderation
- maintaining a moderate weight
- managing your stress level
- eating less salt and more potassium
Depending on your risk factors and your hypertension level, your doctor may recommend one or more prescription drugs to decrease your blood pressure. Medication is always in addition to lifestyle changes.
There are several types of blood pressure lowering medications. They work on different principles.
Discuss with your doctor what drugs might be best for you. It may take a while to find the right combination. Every individual is different.
It’s important to stick to your medication schedule and to consult with your doctor regularly, especially if you notice changes in your blood pressure or your health.
Managing secondary hypertension
If your hypertension is linked to another condition, your doctor will treat the underlying condition first.
Secondary hypertension is usually suspected in people under the age of 30 years who have high blood pressure.
Some clues that point to secondary hypertension are:
- a sudden rise in blood pressure
- needing more than three drugs to keep hypertension under control
- symptoms of renal artery stenosis, thyroid disease, sleep apnea, or other likely causes
If your hypertension is resistant
It may take time for you and your doctor to work out a successful lifestyle and medication plan to lower your blood pressure.
It’s very likely that you’ll find a combination of drugs that works, especially since new medications are always under development.
If your hypertension is resistant, it’s important that you keep working with your doctor and stick with your medication plan.
Hypertension is called the “silent killer,” because it doesn’t usually have identifiable symptoms.
Most cases of hypertension don’t have a known cause. It may be inherited or related to diet and sedentary lifestyle. Also, blood pressure normally tends to increase as you age.
If you have risk factors such as a heart conditionor diabetes, it’s a good idea to monitor your blood pressure regularly and take preventive measures.
Often, lifestyle changes can greatly improve your chances of avoiding hypertension medications and complications, including heart attack or stroke. If lifestyle changes aren’t enough, there’s a variety of prescription medications that can treat your hypertension.
Hypertension fast facts
- About 1 in 3 U.S. adults (75 million people) have high blood pressure, according to the Centers for Disease Control and Prevention.
- About 65 percent of people 60 to 69 years old have high blood pressure.
- Only about 54 percent of people with hypertension have their high blood pressure under control.
- High blood pressure is estimated to cost the United States $48.6 billion each year, including health care services, drugs, and work missed.
- High blood pressure is a major risk factor for heart disease, stroke, and kidney disease.