Millions of people whose blood pressure was considered borderline high or even normal will now learn they fall into the "prehypertension" range, based on new, more aggressive high blood pressure guidelines from the National Institutes of Health.

Because the risk of heart disease and stroke begins to increase at a blood pressure of 115/75 millimeters of mercury (mmHg), health experts lowered the acceptable normal range to urge more aggressive and earlier treatment of high blood pressure.

The guidelines are included in the Seventh Report of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.¹

New classification (2003)		Previous classification (1997)
140/90 or above	High	High	140/90 or above
120-139 / 80-89	Prehypertension	Borderline	130-139 / 85-89
		Normal	129/84 or below
119/79 or below	Normal	Optimal	120/80 or below

• If you have a blood pressure of 120 to 139 systolic (the upper number in a blood pressure measurement) over 80 to 89 diastolic (lower number), you are considered prehypertensive. You need to begin lifestyle modifications to prevent stroke and heart disease. Lifestyle modifications include losing excess weight, exercising, limiting alcohol, following a heart-healthy diet, cutting back on salt, and quitting smoking.
• The increase in stroke and heart disease risk begins at blood pressures as low as 115/75 mmHg and doubles with each increase of 20 mmHg systolic blood pressure and 10 mmHg diastolic. For example, if your blood pressure were to increase from 115/75 mmHg to 135/85 mmHg, your risk of stroke and heart attack would double.
• The lifetime risk for high blood pressure is much greater than previously thought. Ninety percent of those who, at age 55, do not have hypertension will eventually develop it.
• If you are older than 50, a systolic blood pressure over 140 mmHg is a more important risk factor for stroke and heart disease than your diastolic blood pressure.
• Most people who need medication to control their high blood pressure should take a thiazide-type diuretic either alone or with another hypertension medication. You may need initial treatment with other classes of medicationsangiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, or calcium channel blockersif you have other conditions, such as diabetes, heart failure, or chronic kidney disease.
• Most people with high blood pressure will need two or more medications, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mmHg, the goal for people with uncomplicated hypertension. If you have other conditions, such as diabetes, heart failure, or chronic kidney disease, your goal blood pressure is lower: 130/80 mmHg.

¹1Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 03–5233. Bethesda, MD: U.S. Department of Health and Human Services.-->

Author: Ellie Rodgers
Primary Medical Reviewer: Steven L. Schneider, M.D., Family Practice
Specialist Medical Reviewer: Robert A. Kloner, M.D., Ph.D., Cardiology
Last Updated May 16, 2003

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