Stages of Hypertension

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
February 17, 2022

Each time you go to the doctor’s office, your provider probably checks your blood pressure.

This reading can help your healthcare provider understand your risk for certain medical conditions and spot potential high blood pressure (a.k.a. hypertension) early, before it causes any long-term damage

Hypertension doesn’t happen overnight for most.

High blood pressure generally progresses in stages, with an increased risk of heart problems as the condition worsens. Understanding each stage, what it means, and what you can do to reduce your risk of complications can help you manage and even lower your blood pressure.

In this article, I’ll explain what hypertension is and detail the different stages of the condition. I’ll then discuss the risks of hypertension, how it’s treated, and when to see a doctor or primary care provider about high blood pressure.

What Is Hypertension? 

Blood pressure is the force with which the blood pushes against the walls of the arteries (blood vessels that carry blood from your heart to other areas of your body). The more blood your heart pumps through your arteries and the narrower those arteries are, the higher your blood pressure reading will be. 

Blood pressure is measured with two numbers:

  • Systolic blood pressure: The top number of a blood pressure reading, this measures the level of pressure in the arteries each time the heart beats.
  • Diastolic blood pressure: The lower number, this measures the amount of pressure in the arteries when the heart is resting between beats. 

Blood pressure readings are given in millimeters of mercury, or mm Hg. For example, if your systolic pressure is 110 and your diastolic pressure is 70, you would say “110 over 70” or write 110/70 mm Hg.

It’s normal for blood pressure to rise and fall throughout the day. High blood pressure, also called hypertension, occurs when the long-term force of your blood against the walls of your arteries is too high.

This increases your risk for medical problems such as heart disease. 

It’s important to note that high blood pressure may not come with symptoms—and that’s one reason to keep up with routine primary care visits so you can have regular blood pressure readings. 

Types of hypertension

There are two different types of high blood pressure: primary (essential) hypertension and secondary hypertension. 

Primary hypertension is most common.

It usually happens gradually over the course of years and has no specific medical cause.

Instead, you may develop high blood pressure as a result of your lifestyle, such as if you eat an unhealthy diet and are sedentary, age, and genetics.

Secondary hypertension is caused by another medical condition. Unlike primary hypertension, it usually happens suddenly. Risk factors for secondary hypertension include: 

  • Kidney disease
  • Diabetes
  • Pregnancy
  • Being overweight 
  • Thyroid problems
  • Obstructive sleep apnea 
  • Pheochromocytoma (adrenal gland tumors)
  • Blood vessel defects
  • Medications, including birth control, decongestants and cold drugs, over-the-counter painkillers, and certain prescription drugs 
  • Illegal drugs, including cocaine and amphetamines 
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Stages of Hypertension 

As with many health conditions, hypertension can progress over time. Below are the stages of hypertension and what medical providers usually recommend at each stage.

Normal

If your blood pressure is less than 120/80 mm Hg, it’s considered normal blood pressure—and you’re likely at a lower risk for cardiovascular disease.

To maintain this blood pressure, follow a healthy lifestyle, including managing stress, getting enough rest, eating a balanced, nutritious diet and finding time for regular physical activity. 

Elevated

Elevated blood pressure typically reads between 120-129 mm Hg systolic and less than 80 mm Hg diastolic. If you have elevated blood pressure, you’re more likely to develop hypertension, especially if you don’t do anything to prevent it.

Your healthcare provider may recommend lifestyle changes—such as altering your diet or increasing exercise—to protect your health and prevent hypertension from progressing.

Stage 1 hypertension 

If your blood pressure is frequently 130-139 mm Hg systolic or 80-89 mm Hg diastolic, you have stage 1 hypertension and are at a higher risk for cardiovascular disease.

Along with recommending heart-healthy lifestyle practices, your medical provider may prescribe blood pressure medication to lower your risk of a cardiovascular event like a stroke or heart attack.

Stage 2 hypertension 

Stage 2 hypertension occurs when systolic blood pressure is consistently at or higher than 140 mm Hg or diastolic blood pressure is consistently at or higher than 90 mm Hg.

Lifestyle changes may help reduce blood pressure levels at this stage, but a doctor is more likely to also prescribe hypertensive medication. 

Risks of Hypertension 

One high blood pressure reading isn’t necessarily cause for concern. It’s common to have higher blood pressure once in a while, especially in times of stress.

But over time, chronic high blood pressure on the arteries can increase the risk for several serious diseases. 

For one, high blood pressure can cause the arteries to harden and thicken—a condition called atherosclerosis—which can increase the risk for heart attack or stroke. 

Other hypertension risks include: 

  • Heart failure
  • Aneurysm 
  • Kidney failure 
  • Vision loss
  • Metabolic syndrome, which increases your risk of diabetes, heart disease, and stroke
  • Cognitive difficulties, such as trouble with memory or understanding 
  • Dementia 

The higher your blood pressure is and the longer it goes unmanaged, the higher your risk for experiencing medical consequences of hypertension.

Hypertensive urgency 

High blood pressure can come with some major medical risks, but it doesn’t always cause symptoms right away.

Hypertensive urgency, is when you have a very high blood pressure (over 180/120) but do not have any symptoms.

If this occurs, your provider will want to adjust or prescribe medications to make sure this does not continue, as numbers that high can cause serious complications like kidney damage, strokes, or heart attacks.

You do not need to go into an ER for a high blood pressure with no symptoms, but should let your primary provider know right away, and should be seen right away if you do develop any symptoms such as chest pain, vision changes, headache, or shortness of breath

Hypertensive emergency 

A hypertensive emergency, also called a hypertensive crisis, occurs when someone’s blood pressure is so high that they’re at high risk for a medical emergency (or are already experiencing organ failure or another medical crisis).

A hypertensive emergency is more likely when a person’s blood pressure is 180/120 mm Hg or higher, a level that can cause damage to the blood vessels. Some causes of a hypertensive crisis include: 

  • Heart attack 
  • Heart failure
  • Stroke 
  • Kidney failure 
  • Rupture of your body’s main artery (the aorta)
  • Seizures during pregnancy (eclampsia)
  • Forgetting to take blood pressure medicine

If you have an extremely high blood pressure reading, consult your healthcare provider as soon as you can. If you’re also experiencing severe chest pain, headache, and shortness of breath, call 911 or go to the emergency department. 

How to Treat Hypertension 

Hypertension can be serious, but the good news is, it’s manageable—especially if you address it early.

There are many ways to treat hypertension, and your medical provider will determine the best one(s) for you based on your stage and level of disease risk.

Medication 

Each type of blood pressure drug has different benefits and side effects. Some of the most common prescription medications for hypertension include: 

  • Diuretics: Also known as water pills, these help the kidneys excrete sodium and water. Diuretics are usually the first line of treatment for high blood pressure. Common classes of diuretics include thiazide, loop, and potassium-sparing diuretics. 
  • ACE inhibitors: Short for “angiotensin-converting enzyme inhibitors”, these relax blood vessels and block a chemical that constricts them. Common ACE inhibitors include lisinopril (Prinivil, Zestril), benazepril (Lotensin), and captopril.
  • Angiotensin II receptor blockers: Whereas ACE inhibitors stop the formation of a chemical that narrows blood vessels, ARBs stop the action of that chemical. That way blood vessels remain open. Common ARBs include candesartan (Atacand) and losartan (Cozaar).
  • Calcium channel blockers: Often prescribed with ACE inhibitors, these inhibit calcium from entering the heart and artery cells. This causes the heart and arteries to relax and open more. Common calcium channel blockers include amlodipine (Norvasc) and diltiazem (Cardizem and Tiazac).
  • Beta blockers: These block the action of chemicals that increase blood pressure and heart rate. Common beta blockers include metoprolol and propranolol.

If these medications don’t properly control your hypertension, your doctor may prescribe other medications. 

Lifestyle changes

A healthy lifestyle is an important way to prevent hypertension, lower blood pressure, and reduce the impact of high blood pressure. Some of the most significant lifestyle factors include: 

  • Diet: Processed food and fast food can negatively impact blood pressure and overall health, especially if they are high in sodium and fat and low in fiber. Aim for a balanced diet that incorporates fruits and vegetables, whole grains, lean meats like poultry and fish, and low-fat dairy.
  • Weight: People can be healthy at any size, but if you have high blood pressure, your doctor may recommend maintaining a healthy weight or losing weight (if appropriate). Doing so may help reduce how hard your heart has to work.
  • Salt intake: Too much salt can adversely affect blood pressure. Try not to consume more than 1,500 milligrams (mg) of salt per day. Being mindful of how much sodium is in processed foods you consume can help, as can limiting how much you eat out.
  • Exercise: Regular physical activity can improve your overall health and prevent high blood pressure. Try to exercise for a few hours each week, emphasizing moderate and high-intensity aerobic activities that strengthen your heart such as brisk walking, biking, running, and playing tennis.
  • Alcohol: Even moderate drinking may increase the risk of high blood pressure. If you’re an otherwise healthy adult and you wish to drink, aim for 1-2 alcoholic beverages a day at the most.
  • Smoking: Tobacco can cause plaque to build up in your arteries, so if you smoke, speak to your doctor about how to quit.
  • Stress: Stress can cause blood pressure to spike. Seeing a psychotherapist or talking to loved ones about your problems can help, as can mindfulness, meditation, yoga, deep breathing, exercise, and adequate sleep.

Other treatment options 

If you are hypertensive, talk to your doctor before taking any supplements. 

  • Some research suggests fish oil, which is high in omega-3 fatty acids, may be an effective way to lower blood pressure—especially if you have hypertension. 
  • Magnesium supplements may help produce a molecule that relaxes blood vessels, which can lower blood pressure, according to studies on people living with insulin resistance or prediabetes.
  • Potassium—which is found in foods such as bananas, beans, spinach, and broccoli—may protect against high blood pressure. With your doctor’s OK, you can take a potassium supplement. 
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When to See a Doctor

High blood pressure is most effectively treated when it’s caught in the early stages.

So it’s important to schedule routine primary care visits, where your medical provider should take blood pressure readings and let you know if you’re at risk for hypertension.

However, if you think you may be experiencing a hypertensive crisis, go to the emergency department or call 911. Symptoms to watch for include: 

  • Severe chest pain 
  • Severe headache
  • Confusion and blurred vision 
  • Nausea and/or vomiting 
  • Shortness of breath 
  • Anxiety
  • Seizures

Even if you don’t have these symptoms, if you have a concerning spike in blood pressure, seek medical attention.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

What is the main difference between hypertension urgency and emergency?
Hypertensive urgency happens when you have high blood pressure but it hasn’t caused any damage to your organs yet. In a hypertensive emergency, your hypertension is already damaging your organs. Hypertensive emergencies can be life-threatening, so if you think you’re experiencing one, seek immediate medical attention.
How can you measure blood pressure at home?
There are a few ways to measure your blood pressure at home. Manual blood pressure devices are less expensive, but they can be more difficult to use and understand. Digital blood pressure devices cost a bit more, but they’re easier to operate. Some people use wrist blood pressure monitors, but they’re not always as accurate as other alternatives.
What is resistant hypertension?
Many times, medication and lifestyle changes can help manage blood pressure levels. Resistant hypertension happens when even high levels of multiple medications don’t lower someone’s blood pressure enough to reduce their risk of disease. If you have resistant hypertension, your medical provider may check that you’re taking your medication correctly, or they may add more medication that can help protect you from disease risk.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.