What is stage 1 hypertension?
A clinic reading of 140/90 to 159/99, confirmed by home or 24-hour checks. Stage 2 starts at 160/100. Two people at stage 1 can get different tablet advice. Age and a NICE list decide it.
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What is stage 1 hypertension?
Stage 1 is the first stage of high blood pressure in UK guidance. NICE sets it as a clinic reading of 140/90 to 159/99.
One reading isn’t enough. Your home or 24-hour monitor average must also be 135/85 to 149/94.
- Below 120 mmHgIdeal, says Blood Pressure UK.
- 120 to just under 140 mmHgPre-high. Not high blood pressure.
- 140 to just under 160 mmHgStage 1, once home readings confirm it.
- 160 to just under 180 mmHgStage 2, once home readings confirm it.
- 180 mmHg or aboveStage 3 (severe). NICE: organ checks as soon as possible.
Sources: NICE NG136; Blood Pressure UK
The bottom number counts too. The full stage ranges for both numbers are in the next section.
Think of 140 as a speed limit. Stage 1 is a little over it. That doesn’t mean you’ll crash, but it makes a crash more likely.
The NHS says high blood pressure raises the risk of heart attacks and strokes.
Had one high reading? Ask your GP about a home or 24-hour check to confirm it.
What is stage 2 hypertension, and stage 3?
| Stage | At a clinic | Home or 24-hour average |
|---|---|---|
| Stage 1 | 140/90 to 159/99 | 135/85 to 149/94 |
| Stage 2 | 160/100 or higher, but below 180/120 | 150/95 or higher |
| Stage 3 (severe) | Top 180 or more, or bottom 120 or more | Set by the clinic reading |
Source: NICE NG136
Stage 2 is further over the speed limit. For adults of any age with lasting stage 2, NICE says to offer tablets as well as lifestyle advice. For people who are frail or have several long-term health problems, NICE leaves it to the doctor’s judgement.
Why does the step matter? Researchers pooled 61 studies of a million adults. At ages 40 to 69, each 20 points higher on the top number was linked to more than twice the rate of death from stroke.
Stage 3 is a clinic top number of 180 or more, or bottom 120 or more. NICE advises checks for organ damage as soon as possible.
Any stage can feel like nothing. The NHS says there are usually no symptoms, so keep your follow-up checks.
Do I need tablets for stage 1 hypertension?
It depends on your age and a NICE list. Under 80, NICE says to discuss starting tablets if you have 1 or more of these:
- organ damage (harm to the heart, brain, kidneys or eyes)
- heart or circulation disease
- kidney disease
- diabetes
- a 10-year risk of heart or circulation disease of 10% or more
| Person A | Person B | |
|---|---|---|
| Age | 45 | 50 |
| Clinic reading | 150/95 | 150/95 |
| Home average | 142/88 | 142/88 |
| On the NICE list? | No. 10-year risk below 10% | Yes. Type 2 diabetes |
| What NICE says | Lifestyle advice. Consider tablets too. | Lifestyle advice. Discuss starting tablets. |
Source: NICE NG136
That list is the difference. Under 60 and not on the list? NICE says to consider tablets too, because a 10-year score can underestimate your lifetime risk.
Your 10-year risk is a score of how likely a heart or circulation problem is. See cholesterol results for how it works.
Over 80 with stage 1? NICE says to consider tablets if your clinic reading is over 150/90.
Either way, NICE asks your GP to talk through your risk and what you’d prefer, including no tablets. Never stop or change a prescribed medicine without your prescriber.
Why do some sites say 130/80 is stage 1?
They use US numbers. US guidance calls a top number of 130 to 139, or a bottom of 80 to 89, stage 1.
| Clinic reading | UK name | US name |
|---|---|---|
| 120/80 up to 140/90 | Pre-high (not high blood pressure) | Elevated or stage 1 |
| 140/90 to 159/99 | Stage 1, once confirmed | Stage 2 |
| 160/100 or more | Stage 2, once confirmed | Stage 2 |
Sources: Blood Pressure UK; NICE NG136; MedlinePlus
In the UK, Blood Pressure UK calls 120/80 up to 140/90 pre-high. It isn’t high blood pressure, but it’s a little higher than it should be.
If you’re not diagnosed but your clinic reading is below 140/90 and still raised, NICE says to consider checking more often than every 5 years. Ask your GP when to check again.
How can I lower stage 1 blood pressure?
Six NHS changes that help lower blood pressure
- Aim for at least 150 minutes of exercise a week.
- Lose weight if you’re overweight.
- Avoid salty food and adding salt to your meals.
- Avoid drinking more than 14 units of alcohol a week on a regular basis.
- Don’t drink too much caffeine, such as coffee, tea and cola.
- Don’t smoke.
Source: NHS: high blood pressure
NICE offers lifestyle advice at every stage, with or without tablets. The NHS says lowering it even a small amount can help cut your risk.
Pick one change to start this week. For which exercise helps most, see exercise and blood pressure. Before trying a low-salt swap, read salt substitute safety.
When to speak to a GP
Rarely, high blood pressure causes headaches, blurred vision or chest pain. Speak to a GP if:
- Your reading is 140/90 or more at a pharmacy, or your home average is 135/85 or more. Ask about confirming it. See how to measure blood pressure at home.
- You’re 40 or over and haven’t had it checked for more than 5 years. Get it checked at a pharmacy or GP surgery.
- You’re under 40 with high blood pressure. NICE says to consider a specialist check for a cause.
- Your clinic reading is 180/120 or more. NICE advises checks for organ damage as soon as possible. It advises a same-day specialist assessment if you also have new confusion or chest pain. The same goes for signs of heart failure or sudden kidney damage, or bleeding or swelling at the back of the eye.
Get help from NHS 111 if you often have headaches or blurred vision, or chest pain that comes and goes. Also get help for other symptoms you’re worried could be from high blood pressure.
Call 999 for sudden chest pain or discomfort that doesn’t go away, such as squeezing, pressure, burning or indigestion. Also call for pain spreading to either arm, your neck, jaw, stomach or back. Or chest pain with sweating, feeling sick, light-headed or short of breath.