Stages of Hypertension & Treatment Plan According To Your Stage

Hypertension is a long-term disease, also called chronic disease. Its course consists of stages, and you may be diagnosed at any of these stages. Your doctor will advise a treatment plan according to your stage. Thus, you should know about these stages to be aware of your condition.

What are the stages of hypertension?

Stages of hypertension
Hypertension Stages

As mentioned, the course of hypertension consists of four stages:

  1. Prehypertension (elevated blood pressure): The systolic blood pressure ranges between 120mm Hg and 129mm Hg and the diastolic blood pressure is less than 80mm Hg (120-129/80 mm Hg).
  2. Stage 1: The systolic blood pressure ranges between 130mm Hg and 139mm Hg and the diastolic blood pressure ranges between 80mm Hg and 89mm Hg diastolic (130-139/80-89 mm Hg).
  3. Stage 2: The systolic blood pressure is higher than 140mm Hg, and the diastolic blood pressure is higher than 90mm Hg.
  4. Hypertensive crisis: The systolic blood pressure is higher than 180mm Hg, and the diastolic blood pressure is higher than 120mm Hg.


Now, we will discuss the clinical features of these stages and treatment plans suitable for each one of them.

Prehypertension stage

elevated blood pressure (120-129/80 mm Hg):

There are more people at risk to fall in this stage of the disease. Thus, the therapeutic plan at this stage aims to control the blood pressure and prevent hypertension by recommending healthy lifestyle changes to maintain your blood pressure within an acceptable range.

Some healthy lifestyle changes include:

  • A healthy diet mainly consisting of fruit and vegetables and a low amount of fat and salt.
  • Regular exercise, which decreases the risk of obesity and overweight, and the risk of hypertension.
  • Cessation of smoking.
  • Decreased alcohol drinking.
  • Avoid stress.
  • Treatment of any disease that may lead to hypertension, such as kidney diseases or diabetes.
  • A regular check of blood pressure readings to continuously evaluate the condition and take the right steps at the right time.

Read also; What Causes High Blood Pressure?

At this stage, a healthy lifestyle is an adequate therapeutic measure without medications unless the patient suffers from another disease -such as diabetes or kidney disease– and lifestyle modifications can’t control the blood pressure effectively.

Thus, you should follow your doctor’s instructions at this stage to decrease the risk of higher blood pressure stages that may lead to dangerous complications.

Read also; What Are The Complications of Hypertension?

Stage 1 hypertension

Hypertension stage 1 (130-139/80-89 mm Hg):

At this stage, your doctor may continue recommending a healthy lifestyle alone or with some medications.

Therapeutic plans at this stage depend on:

  1. The risk of atherosclerotic cardiovascular diseases (ASCVDs), such as heart failure, which is calculated by the atherosclerotic cardiovascular disease calculator.
  2. The presence of other diseases, such as kidney diseases or diabetes.

If your risk of ASCVDs isn’t high, and you don’t have other diseases, your doctor may continue recommending a healthy lifestyle alone without drugs and recheck your blood pressure every 3 months.

However, if your risk of ASCVDs is high, and you have other diseases, your doctor will likely use a single medication along with lifestyle changes and reassess your blood pressure every month.

The most effective medication at this stage is a thiazide (diuretic), which increases urine output and prevents salt and water retention, thus decreasing your blood pressure. It’s an effective and cheap drug with limited side effects.

Older people during this stage may start their treatment with medications and a healthy lifestyle, even in the absence of the high-risk of ASCVDs or other diseases.

Stage 2 hypertension

Hypertension stage 2 (140/90mm Hg or higher):

At this stage, doctors should put up with a treatment plan consisting of a healthy lifestyle, diuretic medication, and another anti-hypertensive drug. Your doctor may need to include an additional anti-hypertensive medication depending on your status.

Several antihypertensive drugs other than diuretics may be useful at this stage:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors) – Such as captopril (Capoten) and lisinopril (Prinivil), as they prevent the formation of a vasoconstriction-producing substance called angiotensin II.
  • Angiotensin receptors blockers (ARBs) – Such as Losartan (Cozaar) and Valsartan (Diovan), as they block the action of the vasoconstriction-producing substance “angiotensin II.”
  • Calcium channels blockers (CCB) – Such as Amlodipine (Norvasc) and diltiazem (Cardizem), which prevent vasoconstriction and slow the heart rate. This reduces the pressure in your arteries.

At this stage, doctors should check your blood pressure every month to detect any change and make decisions accordingly.

Other factors may affect the treatment plan at this stage:

  • African-American people are more susceptible to hypertension complications and need a stronger treatment plan to control their blood pressure.
  • Other diseases, like kidney diseases, diabetes, or heart failure should be considered in your treatment plan.

Previous stages are usually asymptomatic, but you may experience rare symptoms that include headaches, epistaxis, nausea, vomiting, dizziness, and difficulty breathing. Thus, you should check your blood pressure regularly to avoid a hypertensive crisis that may lead to multi-organ damage.

Hypertensive crisis

Hypertensive crisis (180/120mm Hg or higher):

This stage represents an emergency state, and you need to see your doctor immediately to control your blood pressure and avoid multi-organ damage.

If your blood pressure is 180/120mm Hg or higher, you should wait 5 minutes and measure again. If you find the same high level in the second take, you should see your doctor immediately, especially if you have organ damage-associated symptoms, such as blurred vision, chest pain, difficulty breathing, and back pain. It’s a hypertensive emergency case which may have a poor prognosis if not attended immediately.

Some complications may occur at this stage:

  • Heart failure
  • Angina pectoris (chest pain)
  • Stroke
  • Loss of consciousness
  • Decreased vision or even a complete loss
  • Renal failure
  • Eclampsia (toxemia of pregnancy) in pregnant females

You should check your blood pressure regularly to detect any abnormal increase and seek the treatment to avoid these complications.

At this stage, doctors should strengthen the treatment plan and monitor their patients until their blood pressure returns to acceptable levels. Doctors may need to admit their patients into the intensive care unit (ICU) if there is multi-organ damage to control high blood pressure and prevent further organ failure.