What Are the 4 Stages of Hypertension?

Medically Reviewed on 2/14/2022

4 stages of hypertension

4 Stages of Hypertension
Learn the four stages of hypertension, which include normal, elevated blood pressure, stage I hypertension, and stage II hypertension.

The four stages of hypertension include:

  1. Normal:
    • The systolic pressure is less than 120 mmHg, and the diastolic pressure is less than 80 mmHg; this range is considered normal.
    • There is no need for drugs, but you must follow a healthy lifestyle and may regularly monitor your blood pressure.
  2. Elevated blood pressure:
    • If your systolic blood pressure is between 120 and 129 mmHg and diastolic blood pressure is not above 80 mmHg, you have elevated blood pressure.
    • It identifies people who are at risk of developing stage I or stage II hypertension in the future.
    • This condition does not require medication, but lifestyle changes must be considered.
  3. Stage I hypertension:
    • If your systolic blood pressure is between 130 and 139 mmHg and diastolic blood pressure is between 80 and 89 mmHg, you have stage I hypertension.
    • Your doctor may prescribe antihypertensive medications, such as beta-blockers, calcium channel blockers, and diuretics, and suggest lifestyle changes.
  4. Stage II hypertension:
    • If the systolic pressure exceeds 140 mmHg and the diastolic pressure exceeds 90 mmHg, it is taken very seriously.
    • To prevent complications, such as cardiac and stroke issues, the doctor may recommend more than one drug, lifestyle change, diet, and regular exercise.

According to the new guidelines by the American College of Cardiology and American Heart Association, about 46 percent of adults in the United States are now classified to have high blood pressure.

The American Heart Association defines a hypertensive crisis as a systolic pressure greater than 180 mmHg or a diastolic pressure greater than 120 mmHg. If you notice these blood pressure readings, contact your doctor right away.

What are the different types of hypertension?

Primary hypertension or essential hypertension

  • This is the case for most hypertensive adults.
  • Despite years of research on hypertension, no specific cause has been identified.
  • It is believed to be caused by a combination of genetics, diet, lifestyle, and age.
  • Changes in your diet and lifestyle can help lower your blood pressure and reduce your risk of hypertension complications.

Secondary hypertension

  • Secondary hypertension occurs when your hypertension is caused by an identifiable and potentially reversible cause.
  • The secondary type of hypertension accounts for only about 5 to 10 percent of all cases. It is more common in younger people and affects about 30 percent of people aged 18 to 40 years. 
  • Secondary hypertension is caused by a variety of factors, such as:

Subtypes that fit within the categories of primary or secondary hypertension include:

  • Resistant hypertension:
    • A high blood pressure level that is difficult to control and necessitates multiple medications.
    • When your blood pressure remains above your treatment target despite taking three different types of blood pressure medications, including a diuretic, you are said to have resistant hypertension.
    • Resistant hypertension affects about 10 percent of people with high blood pressure. People with resistant hypertension may have secondary hypertension, which means the cause is yet to be identified, prompting their doctor to look for secondary causes.
    • Most people with resistant hypertension can be successfully treated with a combination of drugs or by identifying a secondary cause.
  • Malignant hypertension:
    • High blood pressure that causes organ damage is referred to as malignant hypertension. This is a life-threatening situation.
    • Malignant hypertension is the most severe type, characterized by elevated blood pressure that is usually greater than 180 mmHg (systolic) or 120 mmHg (diastolic), as well as organ damage.
    • Malignant hypertension has a low prevalence of one to two cases per 100,000 people. Rates may be higher in African American populations.
    • Malignant hypertension is a medical emergency that requires immediate treatment. If you believe you are experiencing a hypertensive emergency, seek immediate emergency medical attention.
  • Isolated systolic hypertension:
    • Isolated systolic hypertension is having systolic blood pressure greater than 130 mmHg and a diastolic blood pressure less than 80 mmHg.
    • It is the most common type of hypertension in older people.
    • About 15 percent of people aged 60 years and older have isolated systolic hypertension. The cause is thought to be artery stiffening with age.
    • Isolated systolic hypertension can also occur in young people. According to studies, isolated systolic hypertension affects two to eight percent of young people.
    • Recent studies showed that younger and middle-aged people with isolated systolic hypertension had a higher risk of stroke and heart attack than those with normal blood pressures.
  • Hypertensive emergency:
    • A hypertensive emergency, also called malignant hypertension, occurs when your blood pressure suddenly rises above 180 mmHg (systolic) or 120 mmHg (diastolic), and you experience symptoms as a result of this sudden rise, such as:
    • This is a potentially fatal condition because high blood pressure can harm vital organs or cause complications, such as an aortic dissection, stroke, or heart attack.
    • If you are experiencing a hypertensive emergency, seek immediate emergency medical attention.
    • Only one to three percent of hypertensive people will experience a hypertensive emergency in their lifetime.
    • Make sure to take your blood pressure medication as directed.
    • Avoid illicit drug usage because they are common causes of hypertensive emergencies.
  • Hypertensive urgency:
    • When your blood pressure is higher than 180/120 mmHg and you have no other symptoms, you have hypertensive urgency.
    • It is critical to treat hypertensive urgency immediately so that it does not progress to a hypertensive emergency.
    • Less than one percent of people with hypertensive urgency are referred to a hospital, and only a small percentage of these suffer adverse effects. It is still a serious condition, and you should call your doctor's office or seek medical attention if you have hypertensive urgency.
  • Whitecoat hypertension:
    • This term refers to when your blood pressure rises temporarily due to being in a doctor's office or another stressful situation, such as being stuck in traffic.
    • Previously, this condition was thought to be harmless. It has recently been linked to an increased risk of cardiovascular disease.
    • People with white coat hypertension frequently progress to a diagnosis of hypertension.


Salt and sodium are the same. See Answer

Is hypertension curable?

No, hypertension is not curable. It is a chronic disease, and the cause of which is unknown in 90 percent of patients. It is, however, treatable with medication and lifestyle modifications, which usually necessitates regular medical attention and follow-ups with your doctor.

To control hypertension, adopt a healthy lifestyle that includes:

  • A balanced diet
  • Quitting smoking
  • Limiting alcohol consumption
  • Cutting back sodium (salt)
  • Managing stress levels
  • Ensuring enough sleep
  • Maintaining body weight and waistline
  • Regular exercise
  • Cutting down excess added sugar and refined carbs
  • Doing breathing exercises and meditation to make your mind calm

Usually, hypertension is treated with:

If you are unable to achieve normal blood pressure levels with these medications, your doctor may advise you to try another medication, such as:

  • Alpha-blockers
  • Alpha-beta blockers
  • Beta-blockers
  • Renin-inhibitors
  • Aldosterone antagonists
  • Central-acting agents
  • Vasodilators

11 complications of hypertension

Hypertension causes a slew of complications and problems with the heart and blood vessels, such as:

  1. Chest pain
  2. Stroke
  3. Dementia
  4. Transient ischemic attack
  5. Mild cognitive impairment
  6. Renal diseases
  7. Eye problems
  8. Type II diabetes
  9. Sexual dysfunction
  10. Bone loss
  11. Sleep troubles

Because hypertension is asymptomatic in the early stages, most are unaware of the condition. As a result, regular blood pressure monitoring is required to avoid any negative outcomes. Early detection is critical because it is a "silent killer" with no symptoms.

  • High blood pressure is a chronic condition that necessitates immediate treatment. 
  • The higher the blood pressure, the greater the risk of serious complications.
  • If you already have hypertension, you should take precautions to keep it from worsening or causing complications.

You should always see your doctor regularly and take your medications exactly as prescribed. Keep a blood pressure monitoring device at home to check your blood pressure regularly.

Health Solutions From Our Sponsors

Medically Reviewed on 2/14/2022
Image Source: iStock Images

Vascular Cures. High Blood Pressure and Vascular Disease. https://vascularcures.org/vascular_diseases/high-blood-pressure-and-vascular-disease/

Cleveland Clinic. High Blood Pressure (Hypertension). https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

Gebreselassie KZ, Padyab M. Epidemiology of Hypertension Stages in Two Countries in Sub-Sahara Africa: Factors Associated with Hypertension Stages. Int J Hypertens. 2015;2015:959256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606448/

American College of Cardiology. New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

RWJBarnabas Health. High Blood Pressure. https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/high-blood-pressure/

Orenstein BW. Understanding the Stages of Hypertension. Everyday Health. https://www.everydayhealth.com/hypertension/understanding-the-stages-of-hypertension.aspx#

Hecht M. Types and Stages of Hypertension. Healthline. https://www.healthline.com/health/types-and-stages-of-hypertension

Felman A. Everything you need to know about hypertension (high blood pressure). Medical News Today. https://www.medicalnewstoday.com/articles/150109