From the Guidelines
High blood pressure is diagnosed through consistent blood pressure measurements taken by a healthcare professional using a blood pressure cuff (sphygmomanometer), with a diagnosis typically requiring at least two elevated readings on separate occasions, and a reading of 130/80 mmHg or higher is considered hypertensive, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Diagnosis of High Blood Pressure
To diagnose high blood pressure, the following steps are taken:
- Repeated office BP measurements on more than one visit, except when hypertension is severe, with three BP measurements recorded at each visit, 1–2 min apart, and additional measurements performed if the first two readings differ by >10 mmHg 1.
- Out-of-office BP measurement with ABPM and/or HBPM, provided that these measurements are logistically and economically feasible, to confirm the diagnosis of hypertension and titrate medication 1.
- Home blood pressure monitoring may also be recommended to track readings over time, using an automated upper arm cuff device taken at the same time each day, to detect white coat hypertension and masked hypertension 1.
Classification of Blood Pressure
The classification of blood pressure is as follows:
- Normal BP level: <130/85mmHg
- High-normal BP level: 130-139/85-89mmHg
- Hypertension BP level: ≥140/90mmHg
Importance of Early Diagnosis
Early diagnosis of high blood pressure is crucial because it often has no symptoms but can lead to serious complications like heart disease and stroke if left untreated, and the 2024 ESC guidelines recommend that the diagnosis of hypertension should be based on repeated office BP measurements and out-of-office BP measurements 1. Some key points to consider when diagnosing high blood pressure include:
- Using a validated BP measuring device with an appropriate cuff size for the individual patient 1.
- Taking multiple readings and reviewing medical history to confirm the diagnosis 1.
- Considering out-of-office BP measurements to detect white coat hypertension and masked hypertension 1.
From the Research
Diagnosing High Blood Pressure
To diagnose high blood pressure, the following steps can be taken:
- Measure blood pressure using a brachial oscillometric ambulatory blood pressure monitor, which can measure systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV), and peripheral resistance (PR) 2
- Compare the measured blood pressure values to the standard guidelines, such as the ESC/ESH guidelines 2
- Monitor blood pressure at baseline, after 3 and 6 months, to track changes and evaluate the effectiveness of treatment 2
- Consider using 24-hour blood pressure monitoring to assess blood pressure variability (BPV) and its impact on cardiovascular outcomes 3
Blood Pressure Measurement
Blood pressure can be measured at peak and trough, 24 hours and 6 hours after the last dose of medication, to evaluate the effectiveness of treatment 4, 5
- Supine and standing blood pressure measurements can be taken to assess orthostatic changes 5
- Blood pressure values can be compared to baseline measurements to evaluate changes over time 2, 4, 5
Predictors of Response to Treatment
The response to treatment can be predicted by: