However, few studies have shown prolonged effectiveness of these interventions and study design has often been poor. Reducing excess weight, salt and alcohol intake coupled with increased exercise all reduce blood pressure. Once a decision has been taken to intervene, and provided that urgent reduction of the blood pressure is not needed, a period of non-drug treatment is recommended. The higher the risk, the sooner treatment should start. 1 The patient's predicted cardiovascular risk, which can be calculated from available tables, 2 should determine the time for intervention. If other risk factors for cardiovascular disease are present, such as hyperlipidaemia, smoking, obesity or a family history, treatment should be started at 140/90-95 mmHg. While there is no absolute cut-off between normal and elevated blood pressure, current guidelines advise treatment for patients whose systolic pressure is 160 mmHg or greater, or whose diastolic pressure is 95-100 mmHg or greater.

These patients commonly have a family history of hypertension, but clinical assessment and selective investigation reveal no primary underlying cause of the hypertension. Hypertension requiring treatment exists when a patient's blood pressure, measured on at least three separate occasions, exceeds the threshold pressures which predict an increased cardiovascular risk, in the absence of complicating features such as diabetes mellitus and overt cardiovascular disease.

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