Topic Overview

The Canadian Hypertension Education Program (CHEP) and the U.S. National Institutes of Health publish guidelines for doctors on high blood pressure classification and treatment. Both guidelines are used in Canada.

If you have high blood pressure, your doctor will give you a blood pressure goal that is based on your health. For example, your goal will depend on whether you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease. Be sure you know your blood pressure goal.

Blood pressure classification
Blood pressure Classification
140/90 or above High risk (hypertension)
121/80 to 139/89 Medium risk (high-normal)
120/80 or below Low risk (ideal)
Treatment for high blood pressure
Blood pressure Treatment

Blood pressure of 121–139 over 80–89 (medium risk [high-normal] blood pressure)

Lifestyle changes

High blood pressure of 140–159 over 90–99

Lifestyle changes, possibly medicines

High blood pressure of 160 over 100 or higher

Medicines plus lifestyle changes

High blood pressure plus organ damage or other risk factors for heart disease

Medicines plus serious lifestyle changes and treatment for the other health problems

Secondary high blood pressure

Medicines, treatment of the condition causing your high blood pressure, or both


People of African, South Asian, First Nations, Inuit or Metis descent are more likely to develop high blood pressure and often have more severe high blood pressure than other groups. It is not known why they are at greater risk.

Older adults

Older adults often have isolated systolic high blood pressure. This problem is sometimes called ISH, for isolated systolic hypertension. In ISH, systolic blood pressure is above 140, but diastolic blood pressure stays lower than 90.

If you are older than 50, a systolic blood pressure (the upper number) over 140 is a more important risk factor for stroke and heart disease than your diastolic blood pressure (the lower number).

This type of high blood pressure is more common in older adults, especially older women. In fact, most people older than 60 who have high blood pressure have ISH.

ISH should be treated, because it can damage organs such as the brain, kidneys, heart, and eyes.

Lifestyle changes might be enough to lower blood pressure. These changes include eating healthy with the DASH diet, losing weight, being active, limiting sodium, and limiting alcohol.

Your doctor may have you take a high blood pressure medicine such as a diuretic.

One problem with treating ISH is that some high blood pressure medicines can cause blood pressure to go too low, causing side effects like light-headedness or a slow heartbeat. And older people are more likely to get these side effects. That's why it's important to monitor your blood pressure and to let your doctor know if you feel dizzy, light-headed, or faint.

Medium risk (high-normal) blood pressure

If you have a blood pressure of 121 to 139 systolic (the upper number in a blood pressure measurement) over 80 to 89 diastolic (lower number), you have medium risk blood pressure. This is blood pressure that is higher than normal but not high enough to be high blood pressure. It is a warning that your blood pressure is going up. You need to begin lifestyle changes to lower your risk for stroke, heart disease, and other problems caused by high blood pressure. For more information, see the topic Medium Risk (High-Normal) Blood Pressure.

Secondary high blood pressure

Secondary high blood pressure treatment depends on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem. Even if the condition that caused your high blood pressure is treated, you may still have to take blood pressure medicine throughout your life.

For more information, see the topic Secondary High Blood Pressure.

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Other Works Consulted

  • Daskalopoulou S, et al. (2015). The 2015 Canadian hypertension education program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31: 549–568.
  • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
  • Fleg JL, et al. (2013). Secondary prevention of atherosclerotic cardiovascular disease in older adults: A scientific statement from the American Heart Association. Circulation, published online October 28, 2013. DOI: 10.1161/01.cir.0000436752.99896.22. Accessed November 22, 2013.
  • Rosendorff C, et al. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation, 131(19): e435–e470. DOI: 10.1161/CIR.0000000000000207. Accessed March 31, 2015.


Adaptation Date: 7/14/2016

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

Adaptation Date: 7/14/2016

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC