You have measured blood pressure, and you see a high blood pressure reading. Don’t panic. A single high reading doesn’t always mean you have a serious problem. Blood pressure fluctuates with every heart beat, and it changes throughout the day. Many factors affect it.
Basics First
Blood pressure is the force of your blood pushing against your artery walls as your heart pumps. It’s measured with two numbers, like “120/80.” The first (top) number is the systolic pressure – the pressure when your heart contracts (beats). The second (bottom) number is the diastolic pressure – the pressure when your heart relaxes between beats. The units are millimeters of mercury (mm Hg), which is just a standard way to measure pressure.
Medical professionals often talk about blood pressure in categories. Hypertension is the medical term for high blood pressure, and hypotension means low blood pressure. According to the American Heart Association, the normal blood pressure is currently defined as 90-120/60-80 mm Hg. Readings consistently above that can be categorized as elevated or different stages of hypertension (Stage 1, Stage 2) depending on how high the numbers are. On the other end, readings that are very low (below about 90/60) are considered low blood pressure (hypotension).
Only one number needs to be high to determine your blood pressure category. If either the top or bottom number is high, use the higher category.
Each category comes with its own recommendations for what to do. Let’s break down each range and the actions you should take.
Low Blood Pressure Reading (Hypotension)
What it is: Low blood pressure is usually defined as a reading lower than 90/60 mm Hg. For example, if your monitor shows 85/55, that’s considered hypotension. By itself, a low reading is often a good thing – it’s usually a sign of healthy blood vessels and heart. Doctors generally don’t label a person with “hypotension” unless low readings cause symptoms.
What to do: In most cases, low blood pressure isn’t harmful as long as you feel fine. Many people have naturally low readings with no issues. If you see a low number on your monitor but you’re not dizzy, lightheaded, or feeling unwell, you likely don’t need to do anything special. Stay hydrated and continue your normal activities. However, if low blood pressure makes you feel faint, weak, or causes blurred vision, you should take it seriously. First, sit or lie down to avoid falling. Drinking some water can help, since dehydration (not having enough fluids) can cause blood pressure to drop. If symptoms persist or you frequently get very low readings, call your doctor. You might need to review your medications or check for underlying causes. But remember, low blood pressure is usually not dangerous unless it causes symptoms.
Normal Blood Pressure
What it is: A normal blood pressure is the range between 90-120/60-80 mm Hg. This is where you want to be. It means your heart and arteries are not under excess strain.
What to do: If your blood pressure reading is in the normal range, that’s great news. Congratulations – this is a healthy reading. You don’t need any immediate action besides maintaining your healthy lifestyle. Keep up good habits that likely helped your blood pressure stay normal. This includes eating a balanced, low-salt diet, staying physically active, managing stress, and not smoking. Normal readings can sometimes fluctuate a bit, so continue to monitor your blood pressure regularly as advised by your healthcare provider. If you consistently stay in this range, you’re doing well. Just use it as motivation to stick with heart-healthy habits.
Elevated Blood Pressure (Pre-Hypertension)
What it is: An elevated blood pressure means your readings are higher than normal but not yet in the high blood pressure (hypertension) range. In U.S. guidelines, this typically refers to a systolic between 120 and 129 mm Hg with a diastolic less than 80. For example, 125/78 would be considered elevated. (Older guidelines used the term “prehypertension” for similar ranges; essentially it’s a warning zone before true hypertension.) According to the AHA, if only the top number is in this range and the bottom number is still below 80, it falls into the “elevated” category. European and WHO guidelines don’t use the word “elevated” as a category, but they similarly consider anything up to about 130-139/85-89 as higher than ideal (often calling it “high-normal”).
What to do: Elevated readings may be comparted to a yellow traffic light, not a red traffic light. This is the time to take action to prevent progression. An elevated blood pressure can turn into high blood pressure unless steps are taken to control it. If you see a reading in this range, you should not ignore it. It’s advisable to recheck your blood pressure again in a few days or weeks (or have your doctor recheck) to see if it’s consistently elevated. Also, look at your lifestyle and see what can be improved.
Now is the perfect time to adopt healthier habits: reduce your salt intake, eat more fruits and vegetables, get regular exercise, limit alcohol, and reduce stress. Lifestyle changes can help lower your blood pressure at this stage. You don’t typically need medication yet for slightly elevated readings, but you should consult your healthcare provider for guidance. They may want to monitor you more closely for a while. The good news is that by acting now – exercising, improving your diet, and maybe losing a little weight if needed – you can often bring your numbers back down to normal and avoid developing hypertension.
High Blood Pressure Reading: Stage 1 Hypertension
What it is: Stage 1 hypertension is the first level of high blood pressure. In the American guidelines, this is defined as a systolic pressure of 130–139 mm Hg or a diastolic of 80–89 mm Hg. For example, 135/85 would fall into Stage 1. This range used to be called “mild” high blood pressure. It’s above normal, but not extremely high. However, health experts changed the definition a few years ago because even these levels can double your risk of heart problems compared to normal blood pressure. It’s worth noting that not all organizations define Stage 1 the same way.
In 2024, the European Society of Cardiology has re-introduced 140/90 mm Hg as the threshold for diagnosing hypertension, now the national hypertension societies will take time to adopt it. In Europe, a reading of 135/85 might be called “high-normal” instead of hypertension. The WHO also considers 140/90 as the level where blood pressure is officially “high”. But regardless of the label, a reading in the 130s/80s is higher than ideal and should be addressed.
What to do: If your monitor shows a Stage 1 hypertensive reading (around the 130s over 80s), don’t panic – but do take it seriously. First, you should recheck your blood pressure on a different day, or at least after a few minutes of rest, to confirm it’s consistently elevated. Home monitors can sometimes give an unexpectedly high number due to user error or temporary factors (maybe you were stressed or had caffeine). So, sit quietly and measure again. If you consistently see readings in this range, it’s important to talk with your healthcare provider.
Your doctor will likely want to confirm the diagnosis of Stage 1 hypertension (usually by averaging multiple readings, sometimes with an office visit or ambulatory monitor). If Stage 1 high blood pressure is confirmed, the first treatment step is usually lifestyle changes. This means your doctor will advise improvements in diet (like cutting salt), exercise, weight management, and so on – similar to the advice for elevated BP, but even more crucial now.
At Stage 1, medication might or might not be prescribed right away, depending on your overall risk. For example, if you have other risk factors like diabetes, kidney issues, or a past heart problem, your doctor may start you on blood pressure medication even at this stage. If you’re otherwise healthy with just mildly high readings, they might give you a few months to work on lifestyle changes first. The key is not to ignore Stage 1 hypertension. It may be “mild,” but it can still damage your arteries over time if left unchecked. With prompt management, you can often prevent it from progressing to more severe levels.
High Blood Pressure Reading: Stage 2 Hypertension
What it is: Stage 2 hypertension is a more significant level of high blood pressure. For instance, a reading of 150/95 or 170/100 would fall into Stage 2. Essentially, once either number (systolic or diastolic) reaches or exceeds those thresholds, it’s Stage 2. At this level, there is no doubt that the blood pressure is high – both American and European guidelines agree that. Higher readings, such as 160/100 or above, are also considered Stage 2 (and sometimes are called “Grade 2” or “Grade 3” hypertension in Europe, indicating moderate to severe levels).
What to do: If your home monitor gives a reading in the Stage 2 range, you should contact your healthcare provider in the near future for evaluation. It doesn’t usually require an ER visit (unless it’s extremely high or you have symptoms – more on that soon), but you shouldn’t delay seeking medical advice. Stage 2 hypertension often requires medication in addition to lifestyle changes to bring it under control. When you inform your doctor, they will likely ask you to come in for a check or will review your home logs. As always, it’s wise to take a second reading after a few minutes to confirm it. Assuming it’s persistently high, your doctor will almost certainly recommend lifestyle modifications (diet, exercise, etc.) if you haven’t already started them. But at Stage 2, lifestyle changes alone might not be enough.
Most patients at this stage will start blood pressure-lowering medication (sometimes more than one) to protect against heart attack or stroke. Don’t be alarmed by the idea of medication – these medicines are very common and can be lifesaving. Also, don’t feel like you’ve “failed” by needing a pill; keeping your blood pressure in a safe range is the goal, by any means that works. While waiting for your appointment, if your blood pressure is, say, 150/95 and you feel okay, you can make some immediate tweaks: avoid salty foods, avoid more caffeine or tobacco that day, and try to relax. But make sure to follow up with your doctor promptly. Uncontrolled Stage 2 hypertension over time can lead to serious health issues, so this is the time to get strict about treatment.
Hypertensive Crisis (Emergency Levels)
What it is: A hypertensive crisis is when blood pressure readings are extremely high, typically higher than 180/120 mm Hg (either number). For example, a reading of 185/125 or 200/130 is in this danger zone. This is sometimes broken down further into “hypertensive urgency” and “hypertensive emergency.” In both cases the numbers are very high; the difference is that in an emergency you’ll have serious symptoms like chest pain or confusion. But in all scenarios, >180/120 (either number) is a critical level. It’s far above normal and puts you at risk of immediate complications. To put it in perspective, this is Grade 3 hypertension in European terms – the highest grade. It’s a medical emergency if confirmed.
What to do: If you ever see a reading this high on your home monitor, take action right away. First, stay calm but act quickly. Wait about five minutes and then recheck your blood pressure to make sure it wasn’t a fluke or error. Sit quietly and ensure you’re using correct technique (cuff fitted properly, etc.). If the second reading is still in the crisis range (still around 180/120 or higher), call your healthcare professional immediately. Do not wait for it to go down on its own. Describe your readings and follow their advice — they will likely tell you to go to the emergency room or take an extra dose of medication if you have one. Importantly, watch for any severe symptoms. Extremely high blood pressure can sometimes cause symptoms like severe headache, chest pain, shortness of breath, vision changes (blurry or loss of vision), numbness or weakness, or difficulty speaking.
If you have any of these symptoms along with a reading over 180/120, call emergency services (911) right away. This could be a hypertensive emergency, which can lead to a stroke or heart attack. Even if you feel fine, blood pressure that high can be silently damaging organs, so it isn’t safe to just ignore it. Let medical professionals evaluate you as soon as possible. In an ER, they can lower your blood pressure safely and check for any complications. The bottom line: a hypertensive crisis is dangerous, so treat it like the emergency it is.
Special Considerations for Older Adults, People with Diabetes, and Pregnancy
Some people need to be extra mindful of blood pressure readings due to their age or health status. Guidelines sometimes adjust targets and treatment approaches for these groups.
Older Adults
Blood pressure tends to creep up with age for many people. Arteries can stiffen over time, and that can lead to higher systolic readings in particular. Older adults (for example, those over 65) still benefit from controlling their blood pressure, but doctors might set slightly different goals. Extremely low blood pressure can be risky in the elderly (because it might cause falls or dizziness), so healthcare providers try to strike a balance. The European guidelines suggest that for people over 65, a reasonable target is to bring systolic blood pressure down to about 130–139 mm Hg (if tolerated).
In very frail or very old patients, the doctor may even be okay with numbers a bit on the higher side, to avoid side effects of medication. If you’re an older adult and you see a high reading like 150/90, you should still follow the same steps (recheck, and contact your doctor for advice on management). Treatment decisions may weigh your overall health. Often, older patients start with lower doses of medication to gently reduce blood pressure. The key is to avoid both extremely high readings and extremely low readings. Make sure to stand up slowly and give your body time to adjust, because older adults can experience something called orthostatic hypotension (a drop in pressure upon standing) which can cause dizziness. Overall, age is not a reason to ignore high blood pressure – it’s actually even more important to control it to prevent strokes – but the approach might be more individualized. Work closely with your healthcare provider to determine the best blood pressure target for you.
Diabetics
People with diabetes need to be especially careful about blood pressure. Diabetes can damage blood vessels over time, and when high blood pressure is added to diabetes, the risk of heart disease, stroke, and kidney problems goes up significantly. For this reason, guidelines often recommend stricter blood pressure control in diabetics. The WHO advises that if you have diabetes (or heart disease, kidney disease, or other high-risk conditions), you should aim for a blood pressure below 130/80 mm Hg. Many doctors will start treatment (lifestyle changes and possibly medication) at lower thresholds for people with diabetes. So if you have diabetes and you see a reading of 130/85 or 135/90, that is already a sign to take action. Don’t wait for it to hit 140/90. You should implement lifestyle changes and likely consult your doctor sooner rather than later. Often, people with diabetes are advised to monitor at home regularly, because keeping blood pressure in a tight range can help protect your kidneys and other organs. In short, “borderline” high blood pressure is less okay when you have diabetes – it’s better to be proactive in getting it down. The good news is many of the healthy habits that control blood sugar (like diet and exercise) also help lower blood pressure.
Pregnancy
Blood pressure is a crucial vital sign during pregnancy. Pregnant women can experience high blood pressure specific to pregnancy, such as preeclampsia, which can be dangerous for both mother and baby. Generally, a blood pressure of 140/90 mm Hg or higher in pregnancy is a red flag. If you’re pregnant and your home monitor shows a reading at or above this level, you should contact your obstetrician or midwife promptly. They will likely want you to come in for a check. Sometimes one high reading doesn’t mean there’s a chronic issue – blood pressure can normally drop in early pregnancy and rise a bit later on – but it could also signal the start of a hypertensive disorder of pregnancy.
Do not ignore a high reading during pregnancy. Preeclampsia, for example, often involves blood pressure 140/90 or above along with other signs like protein in urine or swelling. It requires medical evaluation. Your doctor might recommend medication during pregnancy if blood pressure stays high to keep it in a safer range. Safe blood pressure medicines (like labetalol or methyldopa) are available for pregnant women. Additionally, if you had high blood pressure before getting pregnant (chronic hypertension), you’ll be monitored closely throughout pregnancy. Always let your prenatal care team know about any high readings you record at home. On the flip side, be aware that blood pressure can sometimes drop too low in pregnancy (because the circulatory system expands). So if a pregnant woman feels lightheaded with a low reading, she should also report that. The bottom line is, during pregnancy you have a smaller margin for error – stay in communication with your healthcare providers about your blood pressure, and follow their guidance to keep you and your baby safe.
Conclusion
Seeing a high (or low) number on your blood pressure monitor can be concerning, but understanding the context and knowing what actions to take will help you stay calm and in control. Remember that one reading is just one data point – if you get an unusual result, take a moment, double-check it, and consider the circumstances. Always bring persistent high readings to your doctor’s attention, even if you feel fine. High blood pressure is often called the “silent killer” because it usually doesn’t cause symptoms until damage is done, so regular monitoring and early action are your best protection. The good news is that in many cases, blood pressure can be lowered with lifestyle changes, and effective medical treatments are available for those who need them. By knowing your numbers and following the guidelines (from the AHA, ESC, WHO, and your own doctor’s advice), you’re taking an active role in your health. Those high readings will be much less scary when you know exactly what to do.
Sources
The American Hearth Association
