Reading your numbers
Blood pressure is written as systolic over diastolic (e.g., 124/78). Current U.S. guidelines:
- Normal: below 120/80
- Elevated: 120–129 systolic, diastolic below 80
- Stage 1 hypertension: 130–139 or 80–89
- Stage 2 hypertension: 140+ or 90+
Hypertension is called the silent killer because it usually causes no symptoms while it damages arteries, heart, brain, kidneys, and eyes. Treating it is one of the best-proven life-extending interventions in all of medicine.
Measure it right — half of readings are done wrong
Technique changes readings by 10+ points. For home monitoring:
- Use a validated upper-arm cuff (validatebp.org lists tested devices), with the correct cuff size.
- Sit quietly for 5 minutes first: back supported, feet flat, arm supported at heart level. No caffeine, exercise, or smoking for 30 minutes prior. Empty bladder. No talking.
- Take two readings a minute apart, morning and evening, for a week; bring the log to your appointment. Home averages are more meaningful than one office reading.
Lifestyle: the numbers behind the advice
These effects are additive and, combined, can rival a medication:
- DASH-style eating (vegetables, fruit, whole grains, low-fat dairy, less saturated fat): up to ~11 points systolic.
- Sodium reduction toward 1,500–2,300 mg/day: ~5–6 points. Most sodium comes from packaged and restaurant food, not the shaker.
- Weight loss: roughly 1 point per kg lost.
- Exercise (150 min/week moderate): ~5–8 points.
- Limiting alcohol and potassium-rich foods (unless your doctor restricts potassium): a few points each.
The four first-line medication classes
All four are available as inexpensive generics, and many people need two at low doses rather than one at a high dose (fewer side effects, better control):
- Thiazide diuretics (hydrochlorothiazide, chlorthalidone) — help kidneys remove excess sodium and water.
- ACE inhibitors (lisinopril and others) — relax vessels; kidney-protective in diabetes. A dry cough affects some people.
- ARBs (losartan and others) — similar benefits to ACE inhibitors without the cough; the usual swap.
- Calcium channel blockers (amlodipine and others) — relax vessel walls; ankle swelling is the common quirk.
Which one first depends on your age, kidney function, other conditions, and ancestry-related response patterns — a genuinely individualized decision. If side effects bother you, say so: there are many alternatives, and the goal is a regimen you can live with for decades.
When to seek care urgently
Readings of 180/120 or higher deserve immediate attention: rest five minutes and re-measure. If still that high with chest pain, shortness of breath, weakness, vision change, or difficulty speaking, call 911. If that high without symptoms, contact your clinician promptly the same day.
See also: diabetes guide (the two conditions travel together) and the medication directory.