| Classification of Blood Pressure | ||||||||||
| Category | Systolic (mm Hg) | Diastolic (mm Hg) | ||||||||
| Normal | < 120 | and | < 80 | |||||||
| Prehypertension | 120-139 | or | 80-89 | |||||||
| Stage I Hypertension | 140-159 | or | 90-99 | |||||||
| Stage II Hypertension | > 160 | or | > 100 | |||||||
| Management of Blood Pressure | ||||||||||
| Initial Therapy | ||||||||||
| BP Classification | Lifestyle Modification | w/o compelling indication | w/ compelling indication | |||||||
| Normal | Encourage | None | None | |||||||
| Prehypertensive | Yes | None | Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 | |||||||
| Stage I Hypertension | Yes | Thiazide-type diuretic for most; consider ACEI, ARB, B-blocker, CCB, or combination | Drugs for the compelling indications; other antihypertensives as needed | |||||||
| Stage II Hypertension | Yes | Two drug combos (typically thiazide-type diuretic and ACEI, ARB, B-blocker, or CCB). Use combo with caution in patients at risk for orthostasis | Drugs for the compelling indications; other antihypertensives as needed | |||||||
| Compelling Indications | ||||||||||
| Chronic Kidney Disease | Diabetes Mellitus | |||||||||
| 1. ACE Inhibitiors | 1. ACE Inhibitiors | |||||||||
| 2. Angiotensin Receptor Blockers (ARB's) | 2. Angiotensin Receptor Blockers (ARB's) | |||||||||
| 3. Beta-blocking agents | ||||||||||
| Heart Failure | 4. Calcium channel blockers | |||||||||
| 1. ACE Inhibitiors | 5. Diuretics | |||||||||
| 2. Aldosterone blocking agent | ||||||||||
| 3. Angiotensin Receptor Blockers (ARB's) | High Coronary Risk | |||||||||
| 4. Beta-blocking agents | 1. ACE Inhibitiors | |||||||||
| 5. Diuretics | 2. Beta-blocking agents | |||||||||
| 3. Calcium channel blockers | ||||||||||
| Myocardial Infarction | 4. Diuretics | |||||||||
| 1. ACE Inhibitiors | ||||||||||
| 2. Aldosterone blocking agent | Recurrent Stroke Prevention | |||||||||
| 3. Beta-blocking agents | 1. ACE Inhibitiors | |||||||||
| 2. Diuretic | ||||||||||
| Return to Main Index | ||||||||||