JNC 7 Blood Pressure Classification Criteria
The JNC 7 criteria classify blood pressure into four categories: Normal (<120/<80 mm Hg), Prehypertension (120-139/80-89 mm Hg), Stage 1 Hypertension (140-159/90-99 mm Hg), and Stage 2 Hypertension (≥160/≥100 mm Hg). 1
Blood Pressure Categories
The classification is based on the average of 2 or more properly measured, seated blood pressure readings on each of 2 or more office visits 1:
| BP Classification | Systolic (mm Hg) | Diastolic (mm Hg) |
|---|---|---|
| Normal | <120 | and <80 |
| Prehypertension | 120-139 | or 80-89 |
| Stage 1 Hypertension | 140-159 | or 90-99 |
| Stage 2 Hypertension | ≥160 | or ≥100 |
When systolic and diastolic readings fall into different categories, use the higher category for classification. 1
Key Changes from JNC 6
JNC 7 introduced two major revisions 1, 2:
Introduction of "Prehypertension": This new category (120-139/80-89 mm Hg) identifies individuals at high risk for developing hypertension who need early lifestyle intervention. This is not a disease category but a risk designation 3.
Consolidation of hypertension stages: Former Stage 2 and Stage 3 hypertension were combined into a single Stage 2 category (≥160/≥100 mm Hg) since management approaches are similar 1, 4.
Management Recommendations
For Prehypertension (120-139/80-89 mm Hg):
- Lifestyle modifications are mandatory 1, 2
- No drug therapy based on BP alone
- Exception: Patients with diabetes or kidney disease should receive drug therapy if lifestyle modifications fail to reduce BP to <130/80 mm Hg 1
For Stage 1 Hypertension (140-159/90-99 mm Hg):
- Thiazide-type diuretics should be used for most patients, either alone or combined with other drug classes 2
- Target BP: <140/90 mm Hg (or <130/80 mm Hg with diabetes/chronic kidney disease) 2
For Stage 2 Hypertension (≥160/≥100 mm Hg):
- Consider initiating therapy with 2 agents when BP is >20/10 mm Hg above goal, with one usually being a thiazide-type diuretic 2
- Most patients will require 2 or more medications to achieve goal BP 2
Critical Clinical Points
Systolic BP is the more important cardiovascular risk factor in persons over 50 years of age 2. The relationship between BP and cardiovascular disease risk is continuous—starting at 115/75 mm Hg, cardiovascular disease risk doubles with each 20/10 mm Hg increment 2.
Common pitfall: Individuals who are normotensive at age 55 have a 90% lifetime risk of developing hypertension, emphasizing the importance of identifying and managing prehypertension early 2.