Blood pressure 149 mmHg serious or not should be judged according to the comprehensive analysis of the condition. Blood pressure 149 mmHg belongs to the level of hypertension whether it represents systolic blood pressure or diastolic blood pressure. If the systolic blood pressure is 149mmHg, it belongs to hypertension level 1, although it is mild hypertension, it should be taken seriously and the patient is suggested to further check the electrocardiogram or 24-hour ambulatory electrocardiogram, ambulatory blood pressure, cardiac ultrasound, etc. to understand the fluctuation of blood pressure and whether there are other abnormalities, such as hypertension combined with coronary artery disease, myocardial ischemia or arrhythmia, etc. Comprehensive analysis and judgment to give regular and effective treatment, improve lifestyle blood pressure is still increased, you can start antihypertensive drug therapy. If the diastolic blood pressure 149 mmHg belongs to malignant hypertension, which is very serious, the patient is recommended to be hospitalized.