You checked your blood pressure and the monitor reads 140/90. That number feels alarming, and you are right to take it seriously. A reading of 140/90 mmHg falls into stage 2 hypertension under the current American Heart Association guidelines.
But one high reading does not define your health. What you do next matters far more than the number itself.
What 140/90 Means in Clinical Terms
Blood pressure is measured in two numbers. The top number (systolic, 140 in this case) represents the pressure in your arteries when your heart beats. The bottom number (diastolic, 90) is the pressure when your heart rests between beats.
Current blood pressure categories from the American Heart Association:
- Normal: Below 120/80 mmHg
- Elevated: 120-129 / below 80 mmHg
- Stage 1 Hypertension: 130-139 / 80-89 mmHg
- Stage 2 Hypertension: 140 or higher / 90 or higher mmHg
- Hypertensive Crisis: Above 180 / above 120 mmHg
At 140/90, you are at the entry point of stage 2 hypertension. This is significant because at this stage, the AHA recommends both lifestyle modifications and medication, rather than lifestyle changes alone.
Immediate Steps to Take
Step 1: Do Not Panic
Stress and anxiety raise blood pressure. If you just saw a high number, your anxiety about it is likely pushing the reading even higher. Sit quietly for 5 minutes, take slow deep breaths, and retest.
Step 2: Confirm the Reading
A single reading of 140/90 is not a diagnosis. Blood pressure fluctuates throughout the day based on activity, stress, caffeine, hydration, and even bladder fullness. Take two to three readings, one to two minutes apart, and average them.
For the most accurate home reading:
- Sit in a chair with your back supported and feet flat on the floor
- Rest your arm on a table at heart level
- Do not talk during the measurement
- Avoid caffeine, exercise, and smoking for 30 minutes before testing
- Use the same arm each time (left arm is standard)
Step 3: Track for a Week
Measure your blood pressure twice in the morning and twice in the evening for seven days. Record every reading. This log gives your doctor a much clearer picture than a single office visit measurement, which can be artificially elevated by white-coat hypertension.
Step 4: Schedule a Doctor Appointment
If your average over seven days remains at or above 140/90, you need a medical evaluation. Your doctor will likely order blood work (kidney function, electrolytes, blood glucose, cholesterol) and may check for end-organ damage.
When 140/90 Requires Urgent Care
A blood pressure of 140/90 by itself is typically not an emergency. However, seek immediate medical attention if you also experience:
- Severe headache that feels different from your usual headaches
- Chest pain or tightness
- Shortness of breath
- Vision changes (blurring, double vision)
- Confusion or difficulty speaking
- Numbness or weakness on one side of the body
These symptoms combined with high blood pressure could indicate a hypertensive emergency, stroke, or heart attack. Call 911 immediately.
Lifestyle Changes That Lower Blood Pressure
Lifestyle modifications can reduce systolic blood pressure by 5 to 20 mmHg, potentially bringing 140/90 down into a safer range. Most people need a combination of several changes.
DASH Diet
The Dietary Approaches to Stop Hypertension diet is the most studied dietary intervention for blood pressure. It emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting sodium, saturated fat, and added sugars. Research shows it reduces systolic BP by 8 to 14 mmHg.
Sodium Reduction
Aim for less than 1,500 mg of sodium daily if you have hypertension. The average American consumes over 3,400 mg. The biggest sources are not the salt shaker but restaurant meals, processed foods, bread, deli meats, and canned soups. Reducing sodium by 1,000 mg per day typically lowers systolic BP by 5 to 6 mmHg.
Regular Exercise
150 minutes of moderate aerobic activity per week (brisk walking, cycling, swimming) lowers systolic BP by 5 to 8 mmHg. Consistency matters more than intensity. Walking 30 minutes five days a week is more effective than one intense weekend workout.
Weight Management
For every 2.2 pounds (1 kg) of weight loss, systolic blood pressure drops by approximately 1 mmHg. Losing 10 to 20 pounds can be enough to move you from stage 2 back to stage 1 or elevated. Use our ideal body weight calculator to set a realistic target.
Limit Alcohol
More than one drink per day for women or two for men raises blood pressure. Reducing alcohol intake has one of the fastest impacts on BP, often showing improvement within days.
Quit Smoking
Smoking does not directly cause sustained hypertension, but each cigarette raises blood pressure for 15 to 30 minutes and damages blood vessel walls, making hypertension more dangerous. If you smoke, a nicotine dependence assessment can help you plan your quit strategy.
Manage Stress
Chronic stress contributes to sustained blood pressure elevation. Meditation, deep breathing exercises, and regular physical activity all reduce stress-related BP increases.
Use our blood pressure calculator to categorize your readings, track trends over time, and understand what your numbers mean.
Medication for Stage 2 Hypertension
At 140/90, most guidelines recommend starting antihypertensive medication alongside lifestyle changes. Common first-line medications include:
- ACE inhibitors (lisinopril, enalapril): Relax blood vessels by blocking angiotensin
- ARBs (losartan, valsartan): Similar to ACE inhibitors with fewer side effects for some people
- Calcium channel blockers (amlodipine): Relax blood vessel walls
- Thiazide diuretics (hydrochlorothiazide, chlorthalidone): Reduce blood volume
Your doctor will choose based on your age, ethnicity, kidney function, and other health conditions. Many people need two medications to reach their target BP. This is normal, not a failure.
Target Blood Pressure Goals
For most adults under 65, the target is below 130/80 mmHg. For adults 65 and older, guidelines vary, but most recommend below 130/80 with careful monitoring for side effects like dizziness.
It typically takes four to eight weeks for blood pressure medications to reach full effect. Your doctor will recheck your BP and adjust dosages during this period.
Long-Term Outlook
Stage 2 hypertension is manageable. With proper treatment, most people bring their blood pressure into a safe range within two to three months. The key is starting treatment, sticking with medications, and making sustainable lifestyle changes.
Untreated, however, sustained blood pressure at 140/90 or above significantly increases your risk of heart attack, stroke, kidney damage, and vision loss over time. The heart disease risk calculator can help you understand your overall cardiovascular risk profile.
