when to initiate treatment for borderline hypertension

We used to start treating high blood pressure (hypertension) when it is consistently above 140/90, in order to prevent stroke and heart attack.  Unless there are other risk factor such as high blood sugar and high choleterol, or family history of heart disease and stroke, usually borderine high blood pressure around 140/90 does not need medication.  The best treatment for borderline hypertension or pre-hypertension is life style changes, such as exercise, low salt diet (no more than 1500mg sodium) a day, 5-10 lb weight loss, stop smoking and drinking alcohol etc..  There is new evidence for those over 60 years of age does not need medication treatment until the blood pressure is consistently 150/90. 

The newest hypertension guideline is published in 2014, JN8 (Eighth Joint National Committee) a panel of physician and scientist analysing at what blood pressure without medication treatment would coorelate higher dealth rate (mortality) from heart and kidney diesease, or more hospitalization for heart attack, stroke, dialysis, surgery for revascularization (like cardiac stent).  They found that for peopel over 60 yo, medication should be started after 150/90.  For those who are under 60, the threshold to start medication treatment is 140/90.  


Shawn Hamilton, MD Internal Medicine Physician

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