Blood Pressure 130/90 mmHg Classification According to European Guidelines
No, a blood pressure of 130/90 mmHg is NOT considered hypertension according to the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines—it is classified as "high normal" blood pressure. 1
European Classification System
The ESC/ESH guidelines maintain a hypertension threshold of ≥140/90 mmHg, which differs fundamentally from American guidelines. 1
Your specific blood pressure of 130/90 mmHg falls into the "high normal" category because: 1
- Systolic BP 130-139 mmHg = high normal range
- Diastolic BP 85-89 mmHg = high normal range
- When values fall in different categories, the higher category applies
Complete ESC/ESH Blood Pressure Categories
- Optimal: <120/<80 mmHg 1
- Normal: 120-129/80-84 mmHg 1
- High normal: 130-139/85-89 mmHg 1
- Grade 1 hypertension: 140-159/90-99 mmHg 1
- Grade 2 hypertension: 160-179/100-109 mmHg 1
- Grade 3 hypertension: ≥180/≥110 mmHg 1
Key Difference from American Guidelines
This represents a major divergence from the 2017 ACC/AHA guidelines, which would classify 130/90 mmHg as Stage 1 hypertension. 1, 2 The American threshold is ≥130/80 mmHg, while Europeans retained the traditional ≥140/90 mmHg cutoff. 1
Management Implications for 130/90 mmHg Under European Guidelines
Lifestyle modifications are recommended for individuals with high normal BP (130-139/85-89 mmHg). 1
Antihypertensive medication should only be considered in very-high-risk patients with high normal BP, especially those with established coronary artery disease. 1 This contrasts sharply with routine practice, as most individuals at this BP level would receive lifestyle counseling alone. 1
Diagnostic Confirmation Requirements
Before any classification, proper measurement technique is essential: 1
- Average of ≥2 readings on ≥2 separate occasions
- Confirmation with out-of-office BP monitoring (home or ambulatory) strongly recommended
- Home BP equivalent threshold: ≥135/85 mmHg 2
- 24-hour ambulatory equivalent: ≥130/80 mmHg 2
Clinical Context
The evidence supporting the European approach includes: A 2024 Danish prospective study found that individuals with BP 130-139/80-89 mmHg had a 10-year cardiovascular event risk of 14.1%, which did not differ significantly from those with normal BP at 12.8% (p=0.19). 3 This suggests the European threshold may better identify those at truly elevated cardiovascular risk, though other studies show stage 1 hypertension by ACC/AHA criteria does associate with increased heart failure and atrial fibrillation risk. 4
Both guidelines agree that BP ≥140/90 mmHg constitutes hypertension requiring both lifestyle modification and antihypertensive drug therapy. 1