Blood Pressure Classification: 135/85 mmHg
According to the 2017 ACC/AHA guideline, a clinic blood pressure of 135/85 mmHg is classified as Stage 1 Hypertension (Answer C). 1
Classification Breakdown
The 2017 ACC/AHA guideline establishes the following blood pressure categories 1:
- Normal BP: <120/<80 mmHg
- Elevated BP: 120-129/<80 mmHg
- Stage 1 Hypertension: 130-139/80-89 mmHg
- Stage 2 Hypertension: ≥140/≥90 mmHg
For a reading of 135/85 mmHg, both the systolic (135 mmHg) and diastolic (85 mmHg) values fall within the Stage 1 Hypertension range (130-139/80-89 mmHg). 1
Key Differences from Previous Guidelines
This represents a significant change from the JNC-7 guideline, which defined hypertension as ≥140/90 mmHg. 2 The 2017 ACC/AHA guideline lowered the threshold to ≥130/80 mmHg, reclassifying millions of adults who were previously considered to have "prehypertension" or "high normal" blood pressure. 1, 2
Out-of-Office Blood Pressure Equivalence
The 2017 ACC/AHA guideline recommends confirming office hypertension with out-of-office measurements. 1 For a clinic reading of 135/85 mmHg, the equivalent thresholds are 1:
- Home BP: ≥135/85 mmHg
- Daytime ambulatory BP: ≥135/85 mmHg
- 24-hour ambulatory BP: ≥130/80 mmHg
Clinical Significance
Stage 1 Hypertension defined by the 2017 ACC/AHA guideline (130-139/80-89 mmHg) is associated with increased cardiovascular risk. 3, 4, 5 Research demonstrates that adults with BP in this range who are recommended treatment have CVD event rates of 20.5 per 1,000 person-years, compared to only 3.4 per 1,000 person-years for those not recommended treatment. 3
BP elevation from normal to Stage 1 Hypertension increases the risk of CVD by 23%, ischemic stroke by 32%, and myocardial infarction by 74% in various populations. 4, 5
Treatment Implications
Not all patients with Stage 1 Hypertension require immediate pharmacological treatment. 1 The 2017 ACC/AHA guideline recommends antihypertensive medication for Stage 1 Hypertension only when:
- 10-year ASCVD risk is ≥10%, OR
- Clinical CVD is present, OR
- Chronic kidney disease is present, OR
- Diabetes mellitus is present 1
For patients with Stage 1 Hypertension without these conditions, lifestyle modifications alone are recommended initially. 1