Blood Pressure Classification (BP)
Stage 2 Hypertension
SBP*, mm Hg
≥ 160
DBP*, mm Hg
or ≥ 100
Lifestyle Modification
Yes
Without Compelling Indication
Two-drug combination for most+ (usually thiazide-type diuretic and ACEI or ARB or BB or CCB)
With Compelling Indications
Drug(s) for the compelling indications ++ other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed
*Treatment determined by highest BP category.
+ Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
++ Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mm Hg.
DBP = diastolic blood pressure; SBP = systolic blood pressure.
Drug abbreviations: ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin-receptor blocker; BB = β-Blocker; CCB = calcium channel blocker.
Source: JNC 7, Prevention, Detection, Evaluation and Treatment of High Blood Pressure, NIH, NHLBI Dec 03.
Note: Absence of 10%-20% BP decrease during sleep may indicate increased cardiovascular disease risk.
