What's in this guide
1. What hypertension is
Hypertension — high blood pressure — is the force of blood against your artery walls running consistently above what's healthy. It causes no symptoms in most people, which is why it's called the silent disease. Untreated, it accelerates damage to your heart, brain (stroke risk), kidneys, and eyes. Treated well, it adds years to your life.
The good news: BP is one of the most actionable numbers in medicine. Lifestyle changes work. Medications work. The combination works very well. Almost everyone can get to target with the right plan.
2. Reading your numbers
BP is reported as two numbers, systolic over diastolic — for example, 132/84.
- Systolic (the top number) is the pressure when your heart contracts. It's the more important number for cardiovascular risk in adults over 50.
- Diastolic (the bottom number) is the pressure between heartbeats. It matters more in younger adults.
Categories
| Reading (home or office) | Category |
|---|---|
| <120 / <80 | Normal |
| 120–129 / <80 | Elevated |
| 130–139 / 80–89 | Stage 1 hypertension |
| ≥140 / ≥90 | Stage 2 hypertension |
| ≥180 / ≥120 with symptoms | Hypertensive emergency — see §10 |
One reading doesn't make a diagnosis. The pattern over multiple readings — in office and at home — is what matters.
3. Your BP targets
These reflect the 2025 Hypertension Canada guideline (the most recent national guideline). It now defines high blood pressure as 130/80 or higher, and for most adults the goal is a systolic (top number) below 130 when treatment is well tolerated.
| If you are… | Home BP target |
|---|---|
| Most adults with high BP | Systolic <130 |
| Adult with diabetes | <130/80 |
| Adult with chronic kidney disease | <130/80 |
| Selected very-high-risk patients (your physician's call) | Systolic <120 (more intensive — a specialist option) |
| Frail older adult, postural hypotension, or fall risk | Tailored — often higher target with priority on avoiding lows |
Lifestyle comes first for everyone. If your BP is in the 130–139 range, we usually start with lifestyle changes and add medication if you're at higher cardiovascular risk or if BP stays at or above 140/90. Your target is set on your dashboard and can change as your situation changes.
A note on water pills (thiazide diuretics): national guidelines list them as a first-line option, but because many of our patients have heart-rhythm conditions where these drugs can lower potassium and magnesium (which can trigger arrhythmias), our clinic deliberately uses them later in the sequence, with blood-test monitoring, rather than first.
4. How to measure BP at home
Home measurements are the gold standard for managing BP — they reflect real-life conditions and avoid white-coat effect. Office measurements are valuable but supplemental.
Get the right cuff
Use a validated upper-arm electronic monitor (Omron, Microlife, Withings, A&D, Welch Allyn). Wrist cuffs and finger cuffs are not accurate enough. The cuff size matters — the bladder must wrap 80% around your arm. If you have a large arm, use a "large adult" cuff.
Prepare
Sit quietly for 5 minutes. No caffeine, smoking, or exercise in the prior 30 minutes. Empty your bladder. Take off bulky clothing covering the measuring arm.
Position correctly
Sit with feet flat on the floor, back supported, arm resting on a table at heart level. Cuff over bare skin, lower edge 2–3 cm above the elbow crease.
Two readings, 1 minute apart
Take a reading. Stay seated. Take a second reading 1 minute later. Average the two — that's your value.
Log it
Enter into HeartAge+ daily log. If your wearable connects (e.g., Withings BPM), it autoflows; otherwise type the values.
5. Your weekly measurement schedule
The default schedule (Hypertension Canada home BP protocol):
- 7 days in a row when starting or after a medication change
- Twice daily on each of those days — once morning (within 1 hour of waking, before BP meds), once evening (within 1 hour of bedtime)
- Two readings each time, 1 minute apart, average them
- Skip Day 1 readings (white-coat-corrected) — your physician uses Days 2–7
Once you're stable
Drop to 1–2 days per week of the same pattern. The platform will prompt you when a fuller week is due (typically every 3–4 months unless something changes).
What about wearables?
Some smartwatches now offer cuff-less BP estimation (Samsung Galaxy Watch, certain Apple Watches in some regions). These are useful for trend, but for the readings that drive medication adjustment we still rely on a validated upper-arm cuff. Use both: cuff for the diagnostic reading, watch for the day-to-day trend.
6. Lifestyle that moves the needle
Lifestyle changes can drop BP 5–25 mmHg systolic — that's often equivalent to one or two medications. The big levers, in approximate order:
| Change | Approx. SBP reduction |
|---|---|
| Lose 5–10 kg (if overweight) | 5–20 mmHg |
| DASH-style diet (fruit, vegetables, whole grains, low-fat dairy, low saturated fat) | 8–14 mmHg |
| Reduce sodium to under 2,300 mg/day (~1 tsp) | 2–8 mmHg |
| 30 min aerobic activity most days | 4–9 mmHg |
| Limit alcohol (≤2 drinks/day men, ≤1 women) | 2–4 mmHg |
| Quit smoking | Variable, large cardiovascular benefit beyond BP itself |
| Treat sleep apnea (CPAP if you have it) | 3–10 mmHg |
| Stress / mindfulness practice | Modest, but real |
The platform's nutrition and exercise modules can build a DASH-aligned meal plan and a graduated exercise program for you. They take into account allergies, dietary preferences, and any medications that interact (e.g., grapefruit + some BP meds).
7. Medications and titration
The HeartAge+ HTN module follows the 2020 Hypertension Canada prescription tree.
First-line classes
| Class | Examples | Notes |
|---|---|---|
| ACE inhibitor | ramipril, perindopril, lisinopril | First-line for most. Cough is the common side effect. |
| ARB | candesartan, telmisartan, valsartan | Same effectiveness, no cough. Used when ACE causes cough. |
| Calcium channel blocker (CCB) | amlodipine, felodipine | Often added second. Ankle swelling is the common side effect. |
| Thiazide diuretic | hydrochlorothiazide, indapamide, chlorthalidone | Often added third. Watch potassium. |
How titration works
- You start on a single agent at a starter dose.
- You log home BP for 2–3 weeks.
- Your physician (with the AI titration recommendation tool) reviews. If you're at target — stay. If not — dose increases or a second agent is added.
- Repeat. Most patients hit target within 2–3 medication adjustments. Some need 3–4 medications.
The platform shows you (and your physician) the titration recommendation transparently — you can see why a change is being suggested, and what the next options are.
8. Side effects to know
| Drug class | Common | Rare but important |
|---|---|---|
| ACE inhibitors | Dry cough (~10%); mild dizziness; rise in potassium | Angioedema (face/lip swelling) — stop and call immediately |
| ARBs | Mild dizziness; rise in potassium | Angioedema (very rare) |
| CCBs (amlodipine) | Ankle swelling; flushing; mild headache | Significant low BP if combined with other vasodilators |
| Thiazides | Increased urination first 1–2 weeks; mild low potassium; elevated uric acid (gout risk if predisposed) | Severe low sodium in older patients; severe low potassium |
| Beta-blockers (when added) | Fatigue first 1–2 weeks; cold hands/feet; reduced exercise capacity | Bradycardia in some; bronchospasm in asthmatic patients |
Most side effects either resolve in the first 2 weeks or with a dose adjustment. Don't stop without telling your team — sudden stopping of some BP medications causes rebound hypertension or worse.
9. The daily log and what we watch
What you log: morning BP (two readings, average), evening BP (two readings, average), heart rate, BP medications taken (yes/no per drug), and any symptoms (dizziness, headache, swelling, cough).
What patterns we watch
- Sustained out-of-target readings — 2+ weeks above target triggers a titration review
- Morning surge — much higher morning than evening BP, may need timing adjustment
- Postural drop — symptoms when standing or sitting up, may need dose reduction
- White-coat effect — office readings dramatically higher than home; the platform helps document this so your treatment is based on real-life numbers
- Masked hypertension — office readings normal but home consistently elevated; often missed without home monitoring
- Missed doses — a single skip might be a tell; a pattern triggers a coach reach-out
10. Getting help and what to watch for
Reach out through the portal if:
- You have new dizziness, especially when standing
- You have a new persistent dry cough on an ACE inhibitor
- You have noticeable ankle swelling on a CCB
- You think you missed multiple doses and want guidance on restarting
- Your BP runs consistently below target (e.g., systolic <110 with symptoms)
- You're starting any new medication from any prescriber
Go to emergency or call 911 if:
- Hypertensive emergency: systolic ≥180 or diastolic ≥120 with chest pain, shortness of breath, severe headache, vision change, weakness, slurred speech, or confusion
- Stroke symptoms: face droop, arm weakness, slurred speech, sudden severe headache, sudden vision change
- Chest pain that's new, severe, or different — especially with sweating, nausea, or radiating
- Severe shortness of breath at rest
- Fainting (loss of consciousness)
- Angioedema (face or lip swelling) — life-threatening, do not wait
Where to find things in the portal
| What you want | Where |
|---|---|
| BP daily log | app.heartage.ca → My Pathway → Daily Log |
| BP trend chart with target band | Sidebar → Trends → Blood Pressure |
| Your titration history | Sidebar → My Pathway → Titration Recommendations |
| DASH meal plan | Sidebar → Nutrition → Meal Plan |
| Aerobic exercise plan | Sidebar → Exercise |
| Messages to physician or coach | Sidebar → Messages |