Prehypertension is an older term for blood pressure that is higher than normal but not high enough to meet the current definition of hypertension. Under the 2025 American College of Cardiology and American Heart Association guidelines, the closest category is elevated blood pressure, defined as a systolic pressure of 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg.
Prehypertension usually does not cause noticeable symptoms and is often discovered during a routine blood pressure check. Although elevated blood pressure is not the same as hypertension, it can progress over time and may signal an increased risk of future heart and blood vessel problems.
Treatment generally focuses on healthy lifestyle changes, accurate blood pressure monitoring, and regular follow-up. Medication is not usually needed for elevated blood pressure alone, but it may be recommended if readings progress into the hypertension range or other cardiovascular risk factors are present.
Main symptoms
Prehypertension generally does not cause reliable or noticeable symptoms. Possible findings include:
-
No symptoms at all
-
A higher-than-normal reading during a routine medical appointment
-
Higher readings recorded with a home blood pressure monitor
-
Blood pressure readings that differ between a doctor’s office and other settings
Symptoms such as headaches or dizziness cannot confirm prehypertension because they can have many other causes. Measuring blood pressure is the only reliable way to detect it, and repeated readings are generally needed because a single result may not reflect a person’s usual blood pressure.
What causes prehypertension?
Prehypertension can be the result of:
1. Family history and age
Blood pressure may gradually rise with age as the arteries become less flexible and the cardiovascular system changes. Having close relatives with high blood pressure can also increase the likelihood of developing elevated readings.
These factors cannot be changed, but they can help identify people who may benefit from more frequent blood pressure checks.
2. Excess weight
Being overweight or having obesity can increase the amount of blood the heart must pump through the body. This may place more pressure on the walls of the arteries.
Weight is only one part of cardiovascular health, however. Blood pressure can also be elevated in people whose weight falls within the expected range.
3. Diet
Eating large amounts of sodium may cause the body to retain more fluid, which can raise blood pressure in some people. Diets that include many processed foods may be especially high in sodium.
A diet low in fruits, vegetables, and other potassium-rich foods may also make blood pressure more difficult to manage. Potassium helps balance some of sodium’s effects, although potassium supplements or salt substitutes may not be appropriate for people with certain kidney conditions or those taking particular medications.
4. Physical inactivity
Regular physical activity helps the heart and blood vessels work more efficiently. A lack of activity can contribute to weight gain and may increase the likelihood of elevated blood pressure.
Exercise habits should be adapted to a person’s health and physical ability, especially when heart disease or another chronic condition is present.
5. Tobacco, alcohol, and stress
Tobacco use can temporarily raise blood pressure and damage blood vessels. Drinking excessive amounts of alcohol may also contribute to higher readings.
Stress can cause short-term increases in blood pressure and may encourage behaviors that affect cardiovascular health, such as smoking, drinking alcohol, sleeping poorly, or eating less nutritious foods. Tobacco use, physical inactivity, and stress are also recognized as lifestyle factors associated with the risk of hypertension.
6. Other health conditions
Some medical conditions, including kidney disease, diabetes, and sleep-related breathing disorders, can be associated with higher blood pressure. Certain prescription medications, over-the-counter medications, and stimulants may also affect blood pressure.
A medical evaluation may therefore be needed when readings rise unexpectedly, occur at a young age, or are difficult to control.
Confirming a diagnosis
Blood pressure is recorded using two numbers. Systolic pressure, the upper number, measures pressure while the heart contracts, while diastolic pressure, the lower number, measures pressure between heartbeats.
Under the 2025 ACC/AHA classification, elevated blood pressure is an average systolic reading of 120 to 129 mm Hg with a diastolic reading below 80 mm Hg. Stage 1 hypertension begins at a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg. Classification should be based on an average of at least two careful readings taken on at least two occasions rather than on a single measurement.
When office readings are elevated, measurements taken outside the clinic may be used to confirm the pattern. Ambulatory monitoring records blood pressure automatically over approximately 12 to 24 hours, while home monitoring involves taking readings with an automated device at home. Suspected hypertension should be confirmed outside the clinical setting before treatment begins.
White-coat and masked blood pressure
Some people have higher blood pressure readings in a medical office but normal readings elsewhere. This is known as white-coat hypertension or the white-coat effect.
Masked hypertension is the opposite pattern. Office results appear normal, but blood pressure is elevated at home or during usual daily activities. Monitoring outside the doctor’s office can help identify both patterns and reduce the risk of making a diagnosis based on misleading clinic readings.
Treatment options
Prehypertensino can be treated with a multi-disciplinary approach
1. Lifestyle changes
Healthy lifestyle changes are the main treatment for prehypertension or elevated blood pressure. Recommended measures may include following an eating pattern rich in vegetables, fruits, whole grains, and other minimally processed foods while reducing sodium intake. Reaching or maintaining a healthy weight, getting regular physical activity, avoiding tobacco, limiting alcohol, managing stress in healthy ways, and getting appropriate sleep may also help.
These measures can lower blood pressure and may reduce the risk of developing hypertension and cardiovascular disease.
2. Blood pressure monitoring
Regular monitoring helps determine whether lifestyle changes are working or whether blood pressure is progressing into the hypertension range. People with elevated blood pressure are generally advised to make healthy lifestyle changes and have their blood pressure checked again within three to six months.
Home readings should be taken with a validated upper-arm monitor. The person should sit quietly for about five minutes before the measurement, with the back supported, feet resting on the floor, and the arm supported at heart level.
3. Medication
Blood pressure medication is not generally recommended for elevated blood pressure alone under the 2025 ACC/AHA guidelines. Treatment at this level usually consists of lifestyle changes and follow-up.
Medication may become appropriate if readings meet the criteria for hypertension. Under the 2025 guidelines, treatment decisions for stage 1 hypertension may consider established cardiovascular disease, a previous stroke, chronic kidney disease, diabetes, and the estimated 10-year risk of cardiovascular disease calculated with the PREVENT risk calculator.
Medication is generally recommended for adults with an average blood pressure of 130/80 mm Hg or higher who have cardiovascular disease or an increased 10-year cardiovascular risk. For adults with stage 1 hypertension and a lower estimated risk, medication may be started if blood pressure remains at or above 130/80 mm Hg after three to six months of lifestyle changes. The choice of medication depends on the blood pressure level, overall cardiovascular risk, and other medical conditions.
Prevention measures
Prehypertension cannot always be prevented because age, family history, and other inherited factors may affect blood pressure. However, eating less sodium and fewer highly processed foods, following a balanced diet with plenty of plant-based foods, staying physically active, maintaining a healthy weight, avoiding smoking and other tobacco products, limiting alcohol, managing stress, and checking blood pressure at recommended intervals can help keep blood pressure within a healthier range.
Blood pressure screening is recommended for all adults age 18 and older. Annual screening is considered reasonable for adults age 40 and older and for younger adults with an increased risk, while adults ages 18 to 39 with previous normal readings and no increased risk may be screened less often.
When to see a doctor
A medical appointment is recommended when blood pressure readings repeatedly remain above the normal range, including readings taken at home. Follow-up is especially important when there is a family history of hypertension, excess weight, diabetes, kidney disease, or another cardiovascular risk factor.