The correct response and target blood pressure after discovering elevated blood pressure

What to do if you discover you have high blood pressure: Discovering high blood pressure isn't just a matter of taking medication. You must undergo relevant examinations, such as echocardiography and renal ultrasound, to detect any organ damage caused by high blood pressure as early as possible and treat it promptly.

If you discover high blood pressure for the first time, you must rule out secondary hypertension, meaning the possibility that other diseases are causing the high blood pressure. This is especially important for young patients. Tests include complete blood count, biochemistry, ultrasound of both kidneys, renal arteries, and adrenal glands, as well as blood and urine catecholamines and their metabolites, renin activity, and supine/orthostatic aldosterone levels. If the patient has coexisting cardiovascular disease, kidney disease, diabetes, etc., and their blood pressure is ≥140/90 mmHg, medication should be started immediately. The goal is to control blood pressure while improving organ function. If tolerated, blood pressure should be lowered to at least 130/80 mmHg.

Hypertension is classified into three levels: Stage 1 hypertension (140/90 mmHg ≤ blood pressure < 160/100 mmHg), Stage 2 hypertension (160/100 mmHg ≤ blood pressure < 180/110 mmHg), and Stage 3 hypertension (≥ 180/110 mmHg). When blood pressure exceeds Stage 2 (≥ 160/100 mmHg), medication should be initiated immediately, regardless of target organ damage.

Stage 1 hypertension without organ damage can be managed by first modifying lifestyle for 3 months, observing blood pressure changes, and then deciding whether medication is necessary. Patients with Stage 2 or higher hypertension should take antihypertensive medication while modifying their lifestyle. For general hypertension patients under 65 years of age, blood pressure should be controlled below 140/90 mmHg. Those who can tolerate this and some high-risk patients can further lower it to below 130/80 mmHg. For patients aged 65-79, blood pressure should first be lowered to below 150/90 mmHg, and if tolerated, further lowered to below 140/90 mmHg. Patients over 80 years of age should have their blood pressure reduced to below 150/90 mmHg.