ACSM[042-082]

CHAPTER 3 Pre-Exercise Evaluations 47
TABLE 3.1. CLASSIFICATION AND MANAGEMENT OF BLOOD
PRESSURE FOR ADULTS a
INITIAL DRUG THERAPY
LIFESTYLE WITHOUT WITH
BP CLASSI- SBP DPB MODIFICA- COMPELLING COMPELLING
FICATION mm Hg mm Hg TION INDICATION INDICATIONS
Normal 120 And 80 Encourage
Prehypertension 120–139 Or 80–89 Yes No Drug(s) for
antihypertensive compelling
drug indicated indications b
Stage 1 140–159 Or 90–99 Yes Antihypertensive Drug(s) for
hypertension drug(s) compelling
indicated indications b
Other
antihypertensive
drugs, as
needed
Stage 2 160 Or 100 Yes Antihypertensive
hypertension
drug(s)
indicated
Two-drug
combination
for most c
BP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure.
Adapted from National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2003; 3:5233.
a Treatment determined by highest BP category.
b Compelling indications include heart failure, post–myocardial infarction, high coronary heart disease risk, diabetes,
chronic kidney disease, and recurrent stroke prevention. Treat patients with chronic kidney disease or diabetes to BP
goal of 130/80 mm Hg.
c Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
Adapted from National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2003;3:5233.
hypertension detection and management (11). Table 3.1 summarizes the JNC7
recommendations for the classification and management of BP for adults.
The relationship between BP and risk for cardiovascular events is continuous,
consistent, and independent of other risk factors. For individuals 40 to 70 years of
age, each increment of 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP doubles
the risk of cardiovascular disease across the entire BP range from 115/75 to 185/115
mm Hg. According to JNC7, persons with a systolic BP of 120 to 139 mm Hg or a
diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require
health-promoting lifestyle modifications to prevent cardiovascular disease (2,11).
Lifestyle modification—including physical activity, weight reduction (if
needed), a DASH eating plan (i.e., a diet rich in fruits, vegetables, and low-fat
dairy products with a reduced content of saturated and total fat), dietary sodium
reduction (no more than 100 mmol or 2.4 g sodium/day), and moderation of