Blood Pressure | Quick Guide

📈 BP Classification (AHA/ACC 2023)

Category	Systolic (mmHg)	Diastolic (mmHg)	Action
Normal	<120	<80	Healthy lifestyle; recheck in 1 year
Elevated	120-129	<80	Lifestyle changes; recheck in 3-6 months
Stage 1 HTN	130-139	80-89	Lifestyle changes; medication if 10-yr ASCVD ≥10%
Stage 2 HTN	≥140	≥90	Lifestyle + medication for most patients
Hypertensive Crisis	≥180	≥120	Emergency evaluation - see below

🌿 Lifestyle Modifications (DASH)

Weight loss: 5-20 mmHg reduction per 10 kg lost
DASH diet: Fruits, vegetables, low-fat dairy; reduce saturated fat
Sodium: Reduce to <2.4g/day (ideally <1.5g)
Physical activity: 90-150 min aerobic/week (3-5 mmHg reduction)
Limit alcohol: ≤2 drinks/day men; ≤1 drink/day women
Smoking cessation: Critical for overall CV risk
Stress reduction: Meditation, yoga, counseling

💊 First-Line Pharmacotherapy by Patient Type

Patient Type	Preferred Agent(s)
General (no comorbidities)	Thiazide, ACE-I, ARB, or CCB
Black patients (no CKD/DM)	Thiazide or CCB preferred (ACE-I less effective)
CKD with proteinuria	ACE-I or ARB (renoprotective)
Diabetes	ACE-I or ARB (especially with albuminuria)
Heart Failure with reduced EF	ACE-I/ARB + Beta-blocker + MRA
Post-MI / CAD	Beta-blocker + ACE-I
Pregnancy	Labetalol, Nifedipine, Methyldopa (avoid ACE-I/ARB)
Elderly (≥65)	Target <130/80; start low, go slow

💊 Drug Classes Summary

Class	Examples	Key Side Effects	Contraindications
Thiazide diuretics	HCTZ, Chlorthalidone	Hypokalemia, hyperuricemia, hyponatremia	Gout (relative)
ACE Inhibitors	Lisinopril, Enalapril, Ramipril	Dry cough, hyperkalemia, angioedema	Pregnancy, bilateral renal artery stenosis, angioedema hx
ARBs	Losartan, Valsartan, Olmesartan	Hyperkalemia (less cough vs ACE-I)	Pregnancy, bilateral renal artery stenosis
CCBs (Dihydropyridine)	Amlodipine, Nifedipine	Peripheral edema, flushing, reflex tachycardia	Heart failure with reduced EF (short-acting)
CCBs (Non-DHP)	Diltiazem, Verapamil	Bradycardia, constipation, heart block	HFrEF, AV block, concurrent beta-blockers
Beta-Blockers	Metoprolol, Carvedilol, Atenolol	Bradycardia, fatigue, bronchospasm, masking hypoglycemia	Asthma (non-selective), high-degree AV block
MRAs	Spironolactone, Eplerenone	Hyperkalemia, gynecomastia (spiro)	Hyperkalemia, severe renal impairment

🎯 Treatment Targets

Population	BP Target
General adults	<130/80 mmHg
Age ≥65 (community-dwelling)	<130/80 mmHg
Diabetes	<130/80 mmHg
CKD	<130/80 mmHg
Stroke/TIA history	<130/80 mmHg
Pregnancy (chronic HTN)	<140/90 mmHg

🚨 Hypertensive Crisis

Hypertensive Urgency (no organ damage): BP ≥180/120 but asymptomatic. Oral agents (clonidine, labetalol). Lower BP over 24-48 hrs. Outpatient management often appropriate.

Hypertensive Emergency (with organ damage): Same BP + end-organ damage (AKI, encephalopathy, pulmonary edema, MI, aortic dissection, eclampsia). IV medications (nicardipine, labetalol, nitroprusside). Reduce MAP by 10-20% in first hour, then 25% over 24 hrs. ICU admission.

Hypertension