Blood Pressure 138/90 mmHg: Stage 1 Hypertension – What to Do

A reading of 138/90 mmHg meets criteria for Stage 1 hypertension (ACC/AHA: 130–139/80–89). It often has no symptoms but increases risk of heart attack, stroke, kidney disease, and dementia.

Recommended Actions

1. Confirm: Average ≥2 readings on ≥2 occasions (home monitoring preferred).
2. Lifestyle first: DASH diet, sodium <1,500 mg, weight loss, 150 min/week exercise, limit alcohol, quit smoking, manage stress.
3. Assess 10-yr ASCVD risk: If ≥10% or existing CVD/CKD/diabetes → start medication + lifestyle.
4. If risk <10%: 3–6 month lifestyle trial; reassess.

First-Line Medications

• Thiazide diuretic, ACEi, ARB, or CCB.
• Beta-blockers not first-line unless compelling indication.

Follow-Up

Recheck in 1 month after med initiation; then every 3–6 months at goal. Target: <130/80 for most adults.