For decades, we were told that a blood pressure reading below 120/80 mm Hg was the gold standard for normal. Readings above this were often tolerated unless they crossed 140/90 mm Hg.
However, the recent blood pressure guidelines shifted the paradigm, focusing on prevention and early intervention. According to the guidelines, blood pressure readings between 130-139 mm Hg systolic or 80-89 mm Hg diastolic fall in the Stage 1 hypertension category. Interestingly, the diastolic threshold of 80 mm Hg remains the same as the previous normal, straight up showing that even a slight rise in systolic pressure should not be ignored.
Stage 2 Hypertension is for people with blood pressure readings 140/90 mm Hg or higher. This stage requires immediate attention and often medication in addition to lifestyle changes. Severe Hypertension, also known as Hypertensive Urgency is when readings are over 180/120 mm Hg, even without organ damage, requires immediate treatment to prevent complications like stroke, heart attack, or kidney damage. The message is simple – it is no longer about waiting until blood pressure becomes dangerously high. Instead, the focus is on timely intervention to protect against long-term cardiovascular risk.
Stage 1 Hypertension: Lifestyle comes first
People in Stage 1 hypertension are usually lower-risk, meaning they don’t have major heart disease or organ damage. For them, the first line of treatment is lifestyle modification. People are asked to manage their weight, as losing even 5-10% of body weight can have a measurable impact on blood pressure. DASH diet, which focuses on fruits, vegetables, whole grains and lean proteins, also help while reducing saturated fats. Potassium-rich foods including bananas, oranges, spinach and sweet potatoes help balance sodium levels, and sodium intake should be ideally under 1,500 mg/day for high-risk people. It’s important to stop alcohol, smoking and do regular physical exercises (at least 150 minutes per week). Stress management is equally important. Your doctor will recommend trying these changes for 3-6 months. If blood pressure remains elevated after this period, medications may be introduced.
Stage 2 Hypertension: Medication comes into play
For people with blood pressure above 140/90 mm Hg in consecutive readings, medications are started immediately, alongside lifestyle modifications. Newer guidelines also stress personalised treatment for patients with obesity, chronic kidney disease and other comorbidities like diabetes and vascular diseases. This proactive approach hopes to cut down the risk of heart attacks, strokes and kidney damage and urges people to take action instead of waiting until symptoms appear.
Severe Hypertension aka Hypertensive Urgency
Blood pressure reading over 180/120 mm Hg is considered severe. If there is no evidence of organ damage or if the patient is pregnant, doctors may increase oral antihypertensive medications instead of using IV drugs.
How to Monitor Blood Pressure at Home
Monitoring blood pressure at home is crucial, but accuracy is key. Here’s how to do it correctly-
Use a validated BP monitor (not a smartwatch), trusted brands often have clinical validation. Avoid smoking, caffeine or exercise for at least 30 minutes before measuring. Rest for 5-10 minutes before taking a reading. Take measurements at the same time every day for consistency. Support your arm at heart level and keep both feet flat on the floor. Sit quietly and avoid talking, messaging or scrolling while measuring. Take two readings, one minute apart and record the results. Regularly share home readings with your doctor to track trends and adjust treatment if necessary.
Why Early Intervention Is Important
Previously, readings below 140/90 mm Hg were often overlooked unless symptoms appeared. But research shows that even mildly elevated blood pressure increases the risk of heart disease, stroke and sudden death over time. By acting early, complications can be avoided even before they occur. The message is clear – even a slight rise in blood pressure should not be ignored. By understanding the new guidelines, practicing proper home monitoring and adopting lifestyle changes early, you can protect your heart, kidneys and overall health. Early intervention is not just precaution-it can be life-saving.