What Is Stage 1 Hypertension?

Classification directs treatment of high blood pressure

woman wearing blood pressure cuff
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Blood pressure is something doctors always talk to us about. We understand inherently that having low blood pressure is not good and that having high blood pressure is typically worse. But, beyond that, the hows and whys of blood pressure can be confusing, particularly in regards to what they say about our long-term health.

Understanding Blood Pressure

Blood pressure is simply the measurement of the force of the blood pushing against the walls of our blood vessels.

When the blood pressure is high, we call that hypertension, and, when it is low, we refer to that as hypotension.

The concern with hypertension is that the added pressure within the vessels requires our heart to work harder to pump the blood throughout the body. This elevated pressure contributes to the development of atherosclerosis, or the hardening of arteries. Complications include coronary artery disease (CAD), ​cerebrovascular disease, and kidney disease.

Measuring Hypertension

If a person had elevated blood pressure, the doctor will characterize it as being either prehypertension (indicating a risk of hypertension), stage 1 hypertension (mild to moderate elevation), stage 2 hypertension (moderate to severe elevation), or a hypertensive crisis (considered an emergency).

The doctor will do so simply by taking your blood pressure and measuring the systolic pressure (the pressure during a heartbeat) and the diastolic pressure (the pressure between heartbeats).

The blood pressure is measured in terms of millimeters of mercury, denoted by the symbol mmHg. Based on these measurements, your doctor will describe your blood pressure based on the separate systolic and diastolic values.

For a normal blood pressure, this would translate to a systolic pressure of under 120 mmHg and a diastolic pressure of under 80 mmHg.

For example, a systolic value of 110 and diastolic value of 70 would be described as "110 over 70" and written as "110/70 mmHg."

Why Staging Is Important

The staging of hypertension helps directs the course of treatment and predict the likely outcome (known as the prognosis).

Classifying stage 1 hypertension is important because it is the threshold by which blood pressure treatment is typically started. It is unlike prehypertension where patients will be advised to adjust their lifestyle by exercising, losing weight, reducing fat intake, etc.

The stages of hypertension are delineated as follows:

  • Prehypertension: 120 to 139 over 80 to 89 mmHg
  • Stage 1 hypertension: 140 to 159 over 90 to 99 mmHg
  • Stage 2 hypertension: 160 mm or higher over 100 or higher mmHg
  • Hypertensive crisis: Higher than 180 over higher than 110 mmHg

For persons 60 and over, the values would be adjusted to accommodate the natural physiological changes seen with aging. In this instance, the threshold for stage 1 hypertension would be classified as being higher than 150/90 mmHg.

Symptoms of Stage 1 Hypertension

While people with stage 1 hypertension will often exhibit no outward symptoms, this shouldn't suggest there is not a problem.

As a progressive disease, hypertension will likely worsen if the underlying causes aren't properly addressed. If damage occurs as a result of disease progression, it will often be irreversible.

While stage 1 hypertension is often an "invisible" disease, symptoms can sometimes occur, including:

  • Headache
  • Shortness of breath
  • Dizziness
  • Nosebleed

None of the symptoms should ever be considered normal if they are persistent, recurrent, or worsening. A simple blood pressure reading is all that may be needed to make a diagnosis.

Treatment of Hypertension

The goal of therapy in stage 1 disease is to reduce the person's blood pressure to below 140/90 mmHg.

If the person is diabetic or has chronic kidney disease, the target would be further narrowed to 130/80 mmHg.

In all likelihood, treatment would involve two medications taken from two different classes of drugs, including:

As effective as the pills may be, treatment would still demand that you to address the modifiable factors that contribute to hypertension This would include, among other things the restriction of sodium and saturated fats, routine exercise, a moderation of alcohol intake, and, most importantly perhaps, the cessation of smoking.

Without making these changes, your ability to control your blood pressure may be undermined, especially as you get older.

Source:

Gulec, S. "Diagnosis and treatment of stage 1 hypertension: Which guidelines should we follow?" J Am Soc Hyper. 2014; 8(5):358. DOI: 10.1016/j.jash.2014.02.005.

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