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How is hypertension classified?
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (Joint National Committee 8), published in 2014, continues to classify hypertension by the degree of blood pressure (BP) elevation. The measurement must be based on the average of at least two seated measurements on each of two or more office visits. For children, hypertension is defined as systolic or diastolic BP greater than the 95th percentile of BP for a given age, height, and gender, on repeat measurement.
Classification for Adults 18 Years or Older with Elevated Blood Pressure
BP Category | SBP | DBP | |
---|---|---|---|
Normal | <120 mm Hg | and | <80 mm Hg |
Elevated | 120–129 mm Hg | and | <80 mm Hg |
Hypertension | |||
Stage 1 | 130–139 mm Hg | or | 80–89 mm Hg |
Stage 2 | 140–159 mm Hg | or | 90–99 mm Hg |
Stage 3 | ≥160 mm Hg | or | ≥100 mm Hg |
BP, Blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure.
Classification for Adults 18 Years or Older with Elevated Blood Pressure
Hypertension Stage | SBP | DBP |
---|---|---|
Prehypertension | 120–139 mm Hg | Or 80–89 mm Hg |
Stage I | 140–159 mm Hg | Or 90–99 mm Hg |
Stage II | ≥160 mm Hg | Or ≥100 mm Hg |
DBP , Diastolic blood pressure; SBP , systolic blood pressure.
While national and international guidelines have largely promoted uniform BP targets for all populations (<140/90 for those younger than 80, <150/90 for those older than 80), there is increasing recognition that “goal” BP is patient and comorbid specific. For those with prior strokes, the range of 125 to 135/70 to 80 is desired, whereas 130 to 135/80 is adequate for those with non-proteinuric kidney disease. Finally, among those at low-to-moderate risk for cardiovascular disease without diabetes, 120 to 125/70 to 80 appears to provide maximal benefit. The 2017 ACC/AHA guidelines define the systolic BP target of <130/80 mm Hg for everyone except those with a <10% 10-year risk for cardiovascular (CV) events where it is still <140/90.