Stage I (Mild), Stage II (Moderate), and Stage III (Severe) - Public Safety Medicine

Cardiovascular Disease: Hypertension

sec_arr Stage I (Mild), Stage II (Moderate), and Stage III (Severe)
SECTIONS

Stage I (Mild):

Systolic 140-159 millimeters of mercury (mmHg) or diastolic 90-99 mmHg.

  • No restrictions.
  • Screen for other CVD risk factors (age, sex, total cholesterol, high-density cholesterol, systolic BP, use of anti-hypertensive therapy, diabetes, and current smoking). For the PSW ≥ 40 years of age, use this information to estimate a 2-year or 10-year risk for atherosclerotic cardiovascular disease (ASCVD) defined as coronary death, fatal stroke, nonfatal myocardial infarction, or nonfatal stroke. PSW with >2% risk over the next 2 years or ≥10% risk over the next 10 years should be restricted until a symptom-limiting exercise stress test (EST).4,5
  • Screen for end-organ damage – if end-organ damage is present (see Appendix B), a symptom-limited imaging EST should be performed (see section on Coronary Artery Disease). 6-13
  • Referral to treating healthcare providers for evaluation and treatment.
  • Annual recheck BP and calculate 2-year or 10-year cardiovascular risk 5 
  • Screen for end-organ damage annually.7

 

 

Stage II (Moderate):

Systolic 160-179 mmHg or diastolic 100-109 mmHg

  • No restrictions.
  • Screen for other CVD risk factors (age, sex, total cholesterol, high-density cholesterol, systolic BP, use of anti-hypertensive therapy, diabetes, and current smoking). For the PSW ≥40 years of age, use this information to estimate a 2-year or 10-year cardiovascular risk defined as coronary death, fatal stroke, nonfatal myocardial infarction, or nonfatal stroke. PSW with >2% over the next 2 years or ≥10% risk over the next 10 years should undergo a symptom-limiting EST.4,5
    • Screen for end-organ damage – if end-organ damage is present (see Appendix B), an EST test to 12 METs should be performed (see section on coronary artery disease).8-17,19
  • Referral to treating physician for evaluation and treatment.
  • Recheck BP in 1 month:
    • If BP is <140/90 mmHg, then no restriction and recheck BP every 3 months for 1 year.
    • If BP is reduced to Stage I, then no restriction and recheck BP in 1 month (see section on Stage I for further evaluation). If BP remains in Stage II, provide restrictions until blood pressure is reduced to Stage I or below.
  • Annual recheck BP and calculate 2-year or 10-year cardiovascular risk 5 
  • Screen for end-organ damage annually.7

 

Stage III (Severe):

Systolic ≥180 mmHg or diastolic ≥110 mmHg

  • Provide restrictions.
  • Screen for other CVD risk factors (age, sex, total cholesterol, high-density cholesterol, systolic BP, use of anti-hypertensive therapy, diabetes, and current smoking). For PSWs ≥40 years of age, use this information to estimate a 2- and 10-year risk for atherosclerotic cardiovascular disease (ASCVD) defined as coronary death, fatal stroke, nonfatal myocardial infarction, or nonfatal stroke. LEOs assessed at intermediate or high risk (>2% ASCVD risk over the next 2 years or ≥10% ASCVD risk over the next 10 years) should be restricted until a symptom-limiting EST to 12 METs can be performed (see section on coronary artery disease).18,19
  • Screen for end-organ damage – if end-organ damage is present (see Appendix B), a symptom limited imaging EST should be performed.6-14
  • Referral to healthcare providers for evaluation and treatment.
    • On recheck:
      • If BP is <140/90 mmHg, then no restrictions and recheck BP every 3 months.
      • If BP is in Stage I, then no restrictions, and recheck BP in 1 month. a
      • If BP is in Stage II or III, provide restrictions until blood pressure is reduced to Stage I or a,5,20-23
  • Annual recheck BP and calculate 2-year or 10-year cardiovascular risk 5 
  • Screen for end-organ damage annually.7

 

a This represents a consensus of the Task Force regarding the guidance documents developed by other organizations.20-23