Acceptable Blood Pressure Range for Adults
Normal blood pressure is defined as less than 120/80 mmHg, and this represents the optimal target associated with minimal cardiovascular risk and mortality. 1, 2
Blood Pressure Classification
The 2017 ACC/AHA guidelines establish a clear categorization system that differs significantly from previous recommendations:
- Normal BP: <120/80 mmHg 1, 2, 3
- Elevated BP: 120-129/<80 mmHg 1, 2, 3
- Stage 1 Hypertension: 130-139/80-89 mmHg 1, 2, 3
- Stage 2 Hypertension: ≥140/90 mmHg 1, 2, 3
When systolic and diastolic readings fall into different categories, the higher category should be used for classification. 1
Why <120/80 mmHg is Optimal
The evidence supporting this threshold is compelling:
- Meta-analyses demonstrate that 115/75 mmHg is associated with minimal vascular mortality and represents the true optimal blood pressure from a cardiovascular risk perspective. 4
- The relationship between blood pressure and cardiovascular risk is continuous, graded, and begins well below traditional hypertension thresholds. 5
- By middle age, only approximately 20% of Americans maintain optimal blood pressure levels below 120/80 mmHg, and the majority with higher levels face markedly increased risks of major cardiovascular events and death. 5
Clinical Implications of the "Acceptable" Range
While <120/80 mmHg is normal, readings above this threshold require attention:
- Blood pressure in the 120-129/<80 mmHg range (elevated BP) warrants lifestyle modifications and reassessment in 3-6 months. 1, 2
- Readings of 130-139/80-89 mmHg (Stage 1 hypertension) require nonpharmacological therapy with reassessment in 3-6 months, and medication should be considered for those with high cardiovascular risk (≥10% 10-year ASCVD risk) or existing cardiovascular disease. 1
- Blood pressure ≥140/90 mmHg (Stage 2 hypertension) mandates both lifestyle modifications and pharmacological therapy for all patients. 1, 3, 6
Measurement Requirements
Blood pressure classification must be based on an average of at least 2 readings obtained on at least 2 separate occasions, with proper technique including the patient seated quietly for at least 5 minutes with back supported, feet flat on floor, and arm at heart level. 2, 6
Out-of-office monitoring (home or ambulatory BP monitoring) is essential to confirm diagnosis and exclude white coat hypertension, particularly when office readings are 130-159/80-99 mmHg. 2, 6
Common Pitfalls to Avoid
- Do not accept blood pressure readings of 120-129/80 mmHg as "acceptable" without implementing lifestyle interventions—these patients have elevated BP and increased cardiovascular risk. 1, 5
- Do not rely on single office measurements for diagnosis, as this can lead to misclassification due to white coat effect or measurement error. 2, 6
- Do not assume that blood pressure below 140/90 mmHg is always adequate—treatment targets should be <130/80 mmHg for most patients, especially those with diabetes, chronic kidney disease, or established cardiovascular disease. 1