Stage 1 – average ambulatory/home BPs between 135/85 and 149/94, or clinic BPs 140/90 to 159/99. Treat patients who are under 80 and have a second reason for treatment (CV disease, diabetes, renal disease, target organ damage, or 10-year CV risk 20% or more). Note that in the <40s the risk assessments can underestimate 10-year risk, so consideration of specialist referral for further evaluation is recommended.
Stage 2 – average ambulatory/home BPs 150/95 or higher, or clinic BPs 160/100 or higher. Treatment recommended for all.
Should logically be called Stage 3, though doesn’t seem to be – clinic BP 180/110 or higher. Consider starting treatment straight away without further repeats.
For targets, we’re apparently still allowed to use clinic BPs except in the white coat hypertensives (clinic/home difference >20/10), which makes life a little simpler – targets are <140/90 in the under-80s and <150/90 in the over-80s.
(From BMJ of 3rd September 2011)
Edited to add: NICE guidelines on management of Type 2 DM advise a target of <140/80 routinely, or <130/80 in younger patients or those who have early evidence of end-organ damage (including microalbuminuria or retinopathy) and who also have a good life expectancy.