Merck Manual

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Treatment for High Blood Pressure

Treatment for High Blood Pressure

Blood Pressure (mm Hg)

Low Risk of ASCVD*

High Risk of ASCVD*

Presence of ASCVD*

Elevated blood pressure (120–129 systolic, less than 80 diastolic)

Lifestyle changes

Re-examination in 3–6 months

Lifestyle changes

Re-examination in 3–6 months

Lifestyle changes

Re-examination in 3–6 months

Stage 1 high blood pressure ( 130–139 systolic, 80–89 diastolic)

Lifestyle changes

Re-examination in 3–6 months

Treatment with 1 blood pressure–lowering drug†

Re-examination in 1 month

Treatment with 1 blood pressure–lowering drug†

Re-examination in 1 month

Stage 2 high blood pressure (systolic 140 or higher OR diastolic 90 or higher)‡

Treatment with 2 blood pressure–lowering drugs

Re-examination in 1 month

Treatment with 2 blood pressure–lowering drugs

Re-examination in 1 month

Treatment with 2 blood pressure–lowering drugs

Re-examination in 1 month

* ASCVD = atherosclerotic cardiovascular disease, including coronary artery disease, heart failure, or stroke.

Low risk is considered less than 10%. High risk is 10% or more.

† Lifestyle changes are recommended for all people receiving drug therapy.

‡ For people with blood pressure readings of 140–159/90–100, doctors prescribe two drugs (of different classes) for the initial treatment, and they re-examine the person frequently.