What are the commonly used systems for classifying blood pressure (BP)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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In the United States, the most widely used classification of blood pressure for adults aged 18 years or older is from the 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), as follows [5] :

  • Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
  • Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
  • Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
  • Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

However, in 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults by eliminating the classification of prehypertension and dividing hypertension into two levels [1, 2] :

  • Elevated blood pressure with a systolic pressure between 120 and 129 mm Hg and diastolic pressure less than 80 mm Hg
  • Stage 1 hypertension, with a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg

The 2013 and 2018 ESH/ESC guidelines utilize the following classification system, which was first introduced in its 2002 guidelines [9, 126] :

  • Optimal: Systolic lower than 120 mm Hg and diastolic lower than 80 mm Hg
  • Normal: Systolic 120-129 mm Hg and/or diastolic 80-84 mm Hg
  • High normal: Systolic 130-139 mm Hg and/or diastolic 85-89 mm Hg
  • Grade 1: Systolic 140-159 mm Hg and/or diastolic 90-99 mm Hg
  • Grade 2: Systolic 160-179 mm Hg or greater and/or diastolic 100-109 mm Hg
  • Grade 3: Systolic 180 mm Hg or greater and/or diastolic 110 mm Hg or greater
  • Isolated systolic hypertension: 140 mm Hg or greater and diastolic lower than 90 mm Hg

Both the classifications above are based on the average of two or more readings taken at each of two or more visits after initial screening. [5, 126]  

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