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
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