Managing High Blood Pressure

Regular exercise can help control your blood pressure

High blood pressure (hypertension) is one of the most significant modifiable risk factors for cardiovascular disease. When left untreated, it increases your risk of heart disease, stroke, heart failure, kidney failure, and even dementia. Managing blood pressure effectively is essential to reducing these risks and improving long-term health outcomes.

Even after blood pressure is brought under control, people with a history of hypertension still carry a higher risk of heart disease and stroke compared to those who have always had normal blood pressure. This is why ongoing management is critical.

Understanding Blood Pressure Categories

According to the latest guidelines:

• Normal: Systolic <120 mmHg and Diastolic <80 mmHg

• Elevated: Systolic 120–129 mmHg and Diastolic <80 mmHg

• Stage 1 Hypertension: Systolic 130–139 mmHg or Diastolic 80–89 mmHg

• Stage 2 Hypertension: Systolic ≥140 mmHg or Diastolic ≥90 mmHg

• Hypertensive Crisis: Systolic ≥180 mmHg and/or Diastolic ≥120 mmHg — a medical emergency

When Does Treatment Begin?

Treatment decisions depend on your blood pressure level and your overall cardiovascular risk:

• If your blood pressure is ≥130/80 mmHg and you have an associated condition (e.g., heart disease, diabetes, chronic kidney disease) or a 10-year cardiovascular risk ≥10%, your doctor may recommend immediate medication.

• If you do not have additional risk factors, your provider may start with lifestyle changes for 3 to 6 months, including:

  • Weight loss (if overweight)

  • Regular aerobic exercise

  • Reducing sodium intake

  • Adopting a heart-healthy diet like the DASH or Mediterranean diet

• If lifestyle changes do not reduce your blood pressure below 130/80, medications will likely be recommended.

• Regardless of other health conditions, if your blood pressure is ≥140/90 mmHg, current guidelines recommend starting medications without delay.

What’s the Target Blood Pressure?

• The initial treatment goal is to reduce blood pressure to below 130/80 mmHg.

• Some patients, especially those at high cardiovascular risk, may benefit from aiming for closer to 120/80 mmHg, but this should be individualized.

However, going too low, especially diastolic <70 mmHg in older adults or those with coronary artery disease, may be harmful.

The Good News: High Blood Pressure Is Treatable

Thanks to a wide range of effective medications, most people can control their blood pressure if they take their prescriptions as directed and maintain healthy habits.

If you want to reduce your risk of serious conditions like heart disease, stroke, kidney failure, and cognitive decline, it is vital to:

• Monitor your blood pressure regularly

• Follow medical advice

• Maintain a healthy lifestyle, even if you're on medication

With proper treatment and consistent follow-up, high blood pressure is manageable — and its complications largely preventable.