A systolic blood pressure of 164 mmHg is high. It falls into the category of Stage 2 hypertension, which is the most serious stage before a hypertensive crisis. Under the 2025 guidelines from the American Heart Association and American College of Cardiology, Stage 2 hypertension begins at 140 mmHg systolic or 90 mmHg diastolic, so a reading of 164 sits firmly in that range.
What Stage 2 Hypertension Means
Blood pressure categories exist on a spectrum. Normal is below 120/80. Elevated is 120 to 129 systolic with a normal diastolic number. Stage 1 hypertension covers systolic readings of 130 to 139 or diastolic readings of 80 to 89. Stage 2 picks up at 140/90 and runs up to 179/119. Anything at or above 180/120 is considered a hypertensive crisis.
At 164, you’re roughly in the middle of the Stage 2 range. That’s well past the threshold where lifestyle changes alone are typically sufficient, and it usually calls for medication in addition to diet and exercise adjustments. The distinction matters because the health risks at this level are meaningfully higher than at Stage 1.
The Risks of Staying at 160+
Sustained systolic pressure in the 160 to 179 range carries roughly 3.4 times the risk of dying from coronary heart disease compared to someone with normal blood pressure, based on data from a large study of nearly 348,000 men. For context, risk of stroke or fatal heart disease doubles with every 20-point increase in systolic pressure for adults aged 40 to 69. So moving from 120 to 140 doubles your risk, and moving from 140 to 160 doubles it again.
These aren’t risks that show up overnight. High blood pressure damages blood vessels gradually, stiffening artery walls and forcing the heart to work harder. Over months and years, this increases the likelihood of heart attack, stroke, kidney damage, and heart failure. The higher the number and the longer it stays there, the more damage accumulates.
Before You Worry: Check Your Reading
A single reading of 164 doesn’t necessarily mean you have chronic hypertension. The World Health Organization defines hypertension as systolic readings of 140 or higher on two different days. Stress, caffeine, a full bladder, or even rushing to an appointment can temporarily push your numbers up.
Measurement errors are also surprisingly common. Using a blood pressure cuff that’s too small for your arm can inflate your systolic reading by 5 to 20 mmHg. Sitting on an exam table instead of a chair with back support can add 5 to 15 mmHg. Crossing your legs or letting them dangle adds another 5 to 8 mmHg. Stack a few of these together, and a true reading of 135 could show up as 164 on the monitor.
For the most accurate reading at home, sit in a chair with your feet flat on the floor, rest your arm on a table at heart level, and stay quiet for five minutes before measuring. Use a cuff that fits your arm circumference. Take two readings a minute apart and average them.
What to Do With a 164 Reading
If you get a one-time reading of 164 and feel fine, there’s no need to go to the emergency room. This is not a hypertensive crisis, which starts at 180/120. But it’s not something to ignore either. Recheck your blood pressure after resting for a few minutes in a comfortable position. If it’s still elevated, check again over the next few days at different times.
If your readings consistently land at or above 140, schedule a visit with your doctor soon rather than waiting for your next routine checkup. Stage 2 hypertension typically requires both medication and lifestyle changes to bring under control. Most people start on one or two blood pressure medications, and it can take a few weeks of adjustments to find the right combination and dose.
Lifestyle changes that lower blood pressure include reducing sodium intake (aiming for under 2,300 mg per day, ideally closer to 1,500 mg), regular aerobic exercise like brisk walking for at least 150 minutes per week, maintaining a healthy weight, limiting alcohol, and eating more fruits, vegetables, and whole grains. These changes can lower systolic pressure by 5 to 15 points on their own, but at 164, they’re usually paired with medication rather than tried alone first.
When 164 Requires Urgent Attention
While 164 systolic is below the hypertensive crisis threshold, the number alone isn’t the whole picture. If a reading of 164 comes with any of the following symptoms, get medical help promptly:
- Chest pain or pressure
- Shortness of breath
- Blurred vision or vision changes
- Severe headache
- Numbness or weakness, especially on one side of the body
- Confusion or difficulty speaking
- Nausea or vomiting
These symptoms can signal that high blood pressure is actively damaging an organ, which changes the situation from “schedule an appointment” to “call 911.” Without symptoms, a reading of 164 is a serious warning that needs attention in the coming days, not the coming hours.