Hypertension – When To Treat

See also Antihypertensive Choice

Hypertension: hypertension as having a systolic blood pressure above 140 mm Hg, or a diastolic blood pressure above 90 mm Hg, or both, on at least three separate occasions

Managing hypertesion – when to treat…


If in clinic you take a blood pressure; and it’s Over 140/90 (take a second reading during the consultation)

You offer Home Blood Pressure, or ambulatory blood pressure monitoring…


If that (home or ambulatory) is less than 135/85

Then they’re not hypertensive – you can just monitor.



If it (home or ambulatory) is greater than or equal to 135/85… 

This is Stage One Hypertension….

Treat if:

They are under the age of 80yrs

and they have any one of the following:

  • Target End Organ Damage
  • Established cardiovascular disease
  • Renal Disease
  • Diabetes
  • 10 year cardiovascular risk equivalent to 20% or greater


If it (home or ambulatory reading) is greater than or equal to 150/90… 

This is Stage Two Hypertension…. (also you can categorise it as stage two if you measure it in clinic to be over 160/100)

In that case – you treat all patients regardless of age!



If IN CLINIC the bp is greater or equal to 180/110

  • Consider immediate treatment
  • If any signs of retinal haemorrhage or papilloedema – refer same day to specialist
  • Obviously refer if you suspect a phaeochromocytoma
  • Signs or symptoms of cardiovascular event

Postural Hypotension:

Consider postural hypotension in

  • The Elderly
  • Diabetics
  • Patients with dizziness or falls

Consider routein referral to secondary care if postural drop in systolic BP of 20mmHg