Understand Your Blood Pressure Numbers: Stages of Hypertension Explained

Understanding Your Blood Pressure Numbers: Stages of Hypertension Explained

Blood pressure is one of the key vital signs providing important information about your cardiovascular health. The numbers representing your systolic and diastolic blood pressure can indicate whether you're at risk for hypertension, also known as high blood pressure.

Knowing how to interpret your blood pressure reading can help you understand where you fall on the spectrum of hypertension severity. Your doctor can then better assess your health risks and recommend lifestyle changes or medications to get your blood pressure into a healthy range.

What Do The Blood Pressure Numbers Mean?

Blood pressure is recorded as two numbers, usually written one above or before the other, such as 120/80 mmHg.

The first, or top, number is your systolic blood pressure. This measures the force of blood against the artery walls as the heart contracts and pumps blood to the rest of the body.

The second, or bottom, number is your diastolic blood pressure. This represents the pressure as the heart relaxes between beats while refilling with blood.

Based on these two measurements, you can calculate your pulse pressure. This is your systolic number minus your diastolic number, and indicates the difference between blood pressure during heart contractions and relaxation.

What's Considered Normal Blood Pressure?

Normal blood pressure is below 120/80 mmHg. This is stated as "120 over 80."

Specifically:

• Normal systolic: less than 120 mmHg
• Normal diastolic: less than 80 mmHg

Higher numbers indicate you have hypertension that needs treatment. How high above normal determines the severity.

Stages of Hypertension

There are five hypertension stages based on your systolic and diastolic numbers:

Normal

Systolic: less than 120 mmHg

Diastolic: less than 80 mmHg

Elevated

Systolic: 120-129 mmHg

Diastolic: less than 80 mmHg

Stage 1 Hypertension

Systolic: 130-139 mmHg

Diastolic: 80-89 mmHg

Stage 2 Hypertension

Systolic: 140 mmHg or higher

Diastolic: 90 mmHg or higher

Hypertensive Crisis

Systolic: higher than 180 mmHg

Diastolic: higher than 120 mmHg

As the stages progress, your risk of heart attack, stroke, kidney disease and other complications rises. Aggressive treatment is needed to bring down blood pressure before damage occurs.

Understanding Blood Pressure Category Risks

Here is more detail on health risks associated with each blood pressure stage:

Normal Blood Pressure

A normal reading, especially when consistently below 120/80 mmHg, indicates your cardiovascular health is in good shape. No treatment is needed to lower your pressure.

Focus on maintaining healthy lifestyle habits like exercise, healthy diet, stress management and not smoking to keep your numbers optimal.

Elevated Blood Pressure

An elevated systolic between 120-129 mmHg signals your blood pressure is starting to rise, even though your diastolic remains normal.

You likely don't need medication yet, but should take steps to lower your systolic pressure:

• Exercise regularly
• Maintain healthy weight
• Reduce sodium intake
• Follow DASH diet
• Limit alcohol

Your doctor will monitor your pressure closely to make sure it does not keep climbing into stage 1 range. About 5-10% of people with elevated blood pressure will progress to hypertension within 1 year.

Stage 1 Hypertension

Reaching stage 1 means you have high blood pressure that requires serious attention. Lifestyle changes should be made, and your doctor may prescribe blood pressure medication.

At this stage, you have double the risk of heart disease or stroke compared to those with normal blood pressure. Without treatment, most people in stage 1 eventually progress to more dangerous stage 2.

Stage 2 Hypertension

This severe stage requires prompt treatment with blood pressure medications, along with lifestyle adjustments. Your risk of cardiovascular events like heart attack or stroke jumps significantly.

Stage 2 also accelerates damage to organs like the heart, kidneys and eyes if left uncontrolled. Working urgently to lower your pressure prevents complications like coronary artery disease, vision loss, kidney failure or heart failure.

Hypertensive Crisis

A hypertensive crisis occurs when systolic pressure is over 180 mmHg or diastolic is over 120 mmHg. Without immediate emergency treatment, a hypertensive crisis can lead to a stroke, heart attack, organ damage or death.

A crisis typically requires hospitalization and IV medications to get blood pressure down quickly. Lifestyle measures alone cannot bring numbers down from this dangerous range.

Isolated Systolic vs. Diastolic Hypertension

In some cases, only systolic or only diastolic pressure may be elevated, known as isolated systolic or isolated diastolic hypertension.

Isolated Systolic Hypertension (ISH)

This involves elevated systolic pressure (130 mmHg or above) while diastolic pressure stays within normal range (less than 80 mmHg).

ISH is most common in older adults as arteries stiffen with age. Treatment focuses on lowering systolic pressure, which is the bigger contributor to cardiovascular risk in seniors.

Isolated Diastolic Hypertension

Here, diastolic pressure is elevated (80 mmHg or higher) while systolic remains normal (less than 120 mmHg). This is rare and most often caused by a secondary condition like kidney disease, diabetes or tumors.

Treatment focuses on finding the underlying cause. If it remains unknown, the same lifestyle changes and medications used for regular hypertension can help lower diastolic numbers.

How Does Pulse Pressure Relate to Hypertension?

As discussed earlier, pulse pressure is the difference between your systolic and diastolic numbers. Generally, a pulse pressure:

• Below 40 mmHg is considered low
• Between 40-60 mmHg is normal
• Over 60 mmHg is high

A high pulse pressure (wide gap between systolic and diastolic) is concerning because it signifies stiffened arteries that have lost elasticity. This arterial stiffness increases risk of complications like heart attack and kidney disease.

Ways to improve arterial elasticity and lower pulse pressure include:

• Aerobic exercise
• Strength training
• Stress reduction
• Sodium restriction
• Potassium-rich foods
• Healthy fats like olive oil or avocados

Certain blood pressure medications called diuretics, ACE inhibitors or calcium channel blockers can also improve arterial flexibility.

Determining Your Risk Based on Blood Pressure Numbers

When assessing high blood pressure, doctors consider both your systolic and diastolic numbers, as well as other risk factors like:

• Smoking
• Diabetes
• Obesity
• Sedentary lifestyle
• High cholesterol
• Family history
• Age over 60

The more risk factors present, the higher concern for heart attack, stroke and complications - even if your numbers aren't yet in the severe ranges. Aggressive prevention with lifestyle changes should start early.

Likewise, aiming for blood pressure well below 120/80 provides an extra buffer of protection if you already have multiple risks. Don't wait until you progress into hypertensive stages to take action.

Monitoring Your Blood Pressure

Checking your blood pressure regularly allows you to catch a rising trend early. Guidelines recommend:

• Testing at least once per year if blood pressure is less than 120/80 mmHg
• Testing every 1-3 years if systolic is 120-129 mmHg or diastolic 80-89 mmHg
• Testing at every doctor's visit once stage 1 or 2 hypertension is diagnosed
• Testing monthly or more often to monitor treatment effects

Home monitoring provides a more complete picture than just relying on doctor office readings. Buy a validated home blood pressure monitor and check weekly or daily. Track the numbers to share with your physician.

Don't adjust hypertension medications on your own based on home readings. But alert your doctor promptly if systolic goes above 135 mmHg or diastolic above 85 mmHg consistently.

The Takeaway

Understanding what your blood pressure numbers mean is key for assessing your heart health. Systolic and diastolic readings classify you into normal, elevated, or stage 1 or 2 hypertension zones - each with its own risks and treatment needs.

Monitoring your pressure regularly and maintaining lifestyle habits to keep it in a healthy range are critical. Don't dismiss slightly elevated numbers, as catching hypertension early allows treatment to prevent complications down the road.

Know your blood pressure levels, understand what the numbers signify, and work with your doctor to control high blood pressure before it's too late.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.