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High Blood Pressure (Hypertension)

How is High Blood Pressure Treated?

Tuesday, April 10, 2012 - 10:52

Contributing Author: Guy Slowik FRCS

Although high blood pressure can nearly always be brought down to safe levels, your doctor cannot do it alone. You need to become a partner in your own care.

What Are The Guidelines For Treating High Blood Pressure?

Treatment for high blood pressure consists of lifestyle modifications and drug therapy.

To help doctors identify appropriate treatment for high blood pressure, a group of experts has developed a system that establishes guidelines for treatment. These guidelines are based on the level of blood pressure, associated cardiovascular risk factors, and the presence or absence of damage to other organs and heart disease, referred to as target organ damage and clinical cardiovascular disease.

In this system, high blood pressure is classified by stages, depending on:

  • How high your blood pressure readings are, as well as your risk factors that may make you more likely to have high blood pressure
  • Whether there is any existing heart disease
  • Whether there is any damage to other organs

This classification, which comes from the sixth Joint National Committee's report on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), is referred to as the JNC VI Risk Stratification System.

JNC VI Risk Stratification System

Your Blood Pressure

Your risk group (see below)

 

Risk Group A

Risk Group B

Risk Group C

130-139/85-89

high-normal

 

lifestyle modification

drug therapy

140-159/90-99

(called stage 1 hypertension)

 

lifestyle modification

(up to 12 months)

drug therapy

(up to 6 months)

> or = 160/> or = 100

(Called stages 2 & 3 hypertension)

drug therapy

drug therapy

drug therapy

(Above information adapted from Table 5 from The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI) NIH Publication #98-4080, November 1997; National Heart, Lung and Blood Institute, National Institutes of Health)

  • People in risk group A have either a normal blood pressure but in the upper normal limit, or high blood pressure (either stage 1, 2, or 3) without other risk factors, organ damage, or clinical cardiovascular disease.
    • Those with stage 1 hypertension can first undergo lifestyle modification with frequent blood pressure monitoring. If their target blood pressure is not achieved within one year, drug treatment should then be added.
    • Those with stage 2 or 3 hypertension are treated with medication
  • Most people with hypertension fall into risk group B. They may have a number of risk factors other than diabetes, but do not show evidence of organ damage or clinical cardiovascular disease. Depending on the blood pressure stage and number of risk factors, initial drug treatment may be needed. These individuals should also undergo lifestyle modification.
  • People in risk group C are most in need of prompt drug therapy. These include those with high or high-normal blood pressure who have clinical evidence of target organ damage or clinical cardiovascular disease and/or diabetes, with or without other risk factors. Lifestyle modification is also important in these individuals.

High Blood Pressure (Hypertension)