From the Guidelines
The newest definition of hypertension is a sustained blood pressure of 130/80 mmHg or higher, which was established in 2017, and it is classified into four categories: Normal blood pressure (less than 120/80 mmHg), Elevated blood pressure (120-129/<80 mmHg), Stage 1 hypertension (130-139/80-89 mmHg), and Stage 2 hypertension (≥140/≥90 mmHg) 1.
Classification of Hypertension
The classification system is as follows:
- Normal blood pressure: less than 120/80 mmHg
- Elevated blood pressure: 120-129/<80 mmHg
- Stage 1 hypertension: 130-139/80-89 mmHg
- Stage 2 hypertension: ≥140/≥90 mmHg This classification system helps guide treatment decisions based on severity, with lifestyle modifications typically recommended first for patients with Stage 1 hypertension, and medication therapy usually initiated alongside lifestyle changes for Stage 2 hypertension 1.
Measurement of Blood Pressure
Blood pressure should be measured accurately using proper technique after the patient has been seated quietly for at least 5 minutes, with the arm supported at heart level 1.
Treatment of Hypertension
Common first-line medications for hypertension include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers 1.
Rationale for Classification
The lower threshold for diagnosing hypertension reflects growing evidence that cardiovascular risks begin at lower blood pressure levels than previously recognized, and earlier intervention can reduce long-term complications such as heart disease, stroke, and kidney damage 1.
From the Research
Definition of Hypertension
- The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines define hypertension as a systolic blood pressure (BP) of 130 mmHg or higher, or a diastolic BP of 80 mmHg or higher 2.
- The guidelines also define different stages of hypertension, including:
- Elevated BP: systolic BP between 120-129 mmHg and diastolic BP less than 80 mmHg.
- Stage 1 hypertension: systolic BP between 130-139 mmHg or diastolic BP between 80-89 mmHg.
- Stage 2 hypertension: systolic BP of 140 mmHg or higher, or diastolic BP of 90 mmHg or higher.
Classification of Hypertension
- The guidelines recommend classifying hypertension based on the level of cardiovascular risk, with treatment strategies tailored to the individual's risk profile 2.
- The classification includes:
- Primary prevention: treatment with lifestyle measures plus BP-lowering drugs for individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease of 10% or higher, and an average systolic BP of 130 mmHg or higher, or an average diastolic BP of 80 mmHg or higher.
- Secondary prevention: treatment with lifestyle measures plus BP-lowering drugs for individuals with clinical cardiovascular disease and an average systolic BP of 130 mmHg or higher, or an average diastolic BP of 80 mmHg or higher.
- Studies have shown that BP elevation from normal to stage 1 hypertension is associated with an increased risk of cardiovascular disease and ischemic stroke 3.
- Additionally, research has found that a mean systolic blood pressure of less than 130 mmHg is required to achieve high rates of control to less than 140/90 mmHg 4.