High blood pressure is a leading risk factor for heart attack, stroke, and heart failure.
New guidelines are prompting a closer look at elevated blood pressure readings, even before they reach traditionally defined hypertensive levels. This shift in perspective aims to prevent damage to the heart and blood vessels through more accurate risk assessment and earlier intervention.
120–139/70–89 mmHg: A New Risk Zone Defined
Blood pressure below 120/70 mmHg continues to be considered normal. The newly defined “elevated blood pressure” category includes systolic values between 120 and 139 mmHg and diastolic values between 70 and 89 mmHg. In this range, the risk isn’t solely determined by the numbers on the monitor, but by an individual’s overall risk factors. The Deutsche Hochdruckliga emphasizes that early and consistent treatment of mildly to moderately elevated values can prevent long-term cardiovascular complications, according to 140/90 mmHg: Hypertension is Present Here
A blood pressure of 140/90 mmHg or higher remains defined as manifest arterial hypertension. Treatment is generally recommended at this level to reduce the risk of consequences such as heart attack, stroke, kidney damage, or dementia, as outlined by the Deutsche Herzstiftung in its informational resources (herzstiftung.de). The European society recommends a three-step approach: first, assess pre-existing conditions like heart attack, stroke, or kidney disease; then, calculate the individual’s ten-year risk; and finally—if the situation is unclear—conduct additional tests, such as a coronary calcium score or pulse wave velocity measurement. For individuals with values between 130 and 139 mmHg, the guideline suggests earlier medication if the calculated cardiovascular ten-year risk is at least ten percent. If this risk is less than five percent, lifestyle measures are usually sufficient, according to das-pta-magazin.de. In the intermediate zone of five to ten percent, additional factors such as family history, socioeconomic status, autoimmune diseases, or previous pregnancy complications are considered. Only when this complete picture is available will it be decided whether medication is necessary—or whether close monitoring and non-pharmacological treatment are sufficient. As a general treatment goal, the European society recommends a systolic blood pressure between 120 and 129 mmHg, provided that those affected tolerate this range well. If the upper value is reached, but the lower value cannot be lowered below 80 mmHg, additional therapy intensification may be considered individually. For very elderly or frail people, as well as individuals with a severely limited life expectancy, a more moderate target below 140/90 mmHg may be appropriate. For fit older people under 85 years of age, a target of around 120 to 129/80 mmHg is still recommended to protect the heart and blood vessels as much as possible, reports das-pta-magazin.de. In addition to medication, lifestyle remains a central lever. The guideline recommends at least 150 minutes of endurance activity per week and a Mediterranean or DASH-oriented diet. Daily sodium intake should be limited to two grams—equivalent to about five grams of table salt. People with hypertension should consume less than 100 grams of alcohol per week, roughly equivalent to one standard drink per day or less. An additional potassium intake of 0.5 to one gram per day through potassium-rich foods or potassium-enriched, sodium-reduced salt is now emphasized, provided there is no relevant kidney disease. These measures can support blood pressure medication and help delay medication in cases of slightly elevated values. (This article was created in cooperation with promipool.de)10‑Percent Threshold: When Medication May Be Beneficial
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