The 1997 categories were optimal, normal, high-normal, and
hypertension stages 1, 2, and 3. Stages 2 and 3 were combined because
their treatment is essentially the same.
The guidelines do not recommend drug therapy for those with
prehypertension unless it is required by another condition, such as
diabetes or chronic kidney disease. But the report advises them-and
encourages those with normal blood pressures-to make any needed
lifestyle changes. These include losing excess weight, becoming
physically active, limiting alcoholic beverages, and following a
heart-healthy eating plan, including cutting back on salt and other
forms of sodium. For FOH staff who detect prehypertension levels in
clients, it would be prudent to:
provider for treatment evaluations, especially if they have other
- Recommend lifestyle changes, including
smoking cessation if applicable
- Follow-up with additional readings if
- Refer clients to their primary healthcare
As in the 1997 guidelines, the new report recommends Americans
follow the DASH-Dietary Approaches to Stop Hypertension-eating plan,
which is rich in vegetables, fruit, and nonfat dairy products.
Simplified and strengthened drug treatment recommendations to
include the use of diuretics and other drug classes in initial regimens
such as angiotensin converting enzyme (ACE) inhibitors, angiotensin
receptor blockers, beta-blockers, and calcium channel blockers.
According to the new report, most persons will need two, and at times
three or more, medications to lower blood pressure to the desired
The guidelines also recommend clinicians work with patients to
agree on blood pressure goals and develop a treatment plan.
For more detailed information on the new guidelines, please go to the
following NIH website: www.nhlbi.nih.gov/new/press/03-05-14.htm