What are the acceptable blood pressure ranges by age for a general adult population with no underlying medical conditions?

Acceptable Blood Pressure Ranges by Age

For adults of all ages without underlying medical conditions, normal blood pressure is defined as <120/80 mm Hg, with elevated BP at 120-129/<80 mm Hg, and hypertension beginning at ≥130/80 mm Hg, regardless of age. 1

Blood Pressure Classification (Applies to All Adults ≥18 Years)

The 2017 ACC/AHA guidelines provide the current standard classification that does not vary by age for diagnosis 1:

• Normal BP: <120/80 mm Hg 1
• Elevated BP: 120-129 mm Hg systolic AND <80 mm Hg diastolic 1
• Stage 1 Hypertension: 130-139 mm Hg systolic OR 80-89 mm Hg diastolic 1
• Stage 2 Hypertension: ≥140 mm Hg systolic OR ≥90 mm Hg diastolic 1

This represents a significant departure from older JNC 7 guidelines (2003), which defined hypertension as ≥140/90 mm Hg 1. The 2017 guidelines lowered the threshold based on observational data showing a continuous gradient of cardiovascular risk starting well below 140/90 mm Hg 1.

Age-Related Context (Not Different Diagnostic Thresholds)

While the diagnostic thresholds remain the same across all ages, the approach to these numbers differs by age group:

Adults <60 Years

• Normal BP remains <120/80 mm Hg 1
• These individuals should be encouraged to maintain optimal BP through lifestyle modifications 1
• The lifetime risk of developing hypertension is extremely high: 93% for African Americans, 92% for Hispanics, 86% for whites, and 84% for Chinese adults by age 85 1

Adults 60-79 Years

• The same BP classification applies (<120/80 mm Hg is normal) 1
• However, treatment targets may differ from diagnostic thresholds (treatment goals are discussed separately from what constitutes "normal" BP) 2
• The 2024 ESC guidelines recommend a systolic BP target of 120-129 mm Hg for most adults in this age range if tolerated 1, 2

Adults ≥80 Years

• Normal BP is still defined as <120/80 mm Hg 1
• More lenient treatment targets (130-139 mm Hg systolic) may be considered for those with frailty, symptomatic orthostatic hypotension, or limited life expectancy 2, 3
• The diagnostic threshold does not change, but clinical judgment about intervention intensity does 3

Critical Distinction: Diagnosis vs. Treatment Targets

A common pitfall is confusing what constitutes "normal" BP (diagnostic threshold) with treatment goals. The acceptable BP range for diagnosis is uniform across ages, but treatment intensity and targets are individualized 2, 3. For example:

• A 70-year-old with BP of 135/85 mm Hg has Stage 1 hypertension by definition 1
• Whether to treat with medication (vs. lifestyle only) and how aggressively depends on cardiovascular risk, comorbidities, and tolerability 1, 2

European Guidelines Comparison

The 2024 ESC guidelines align closely with ACC/AHA on diagnostic thresholds, defining hypertension as BP ≥140/90 mm Hg for treatment initiation, though they recommend considering treatment at 130-139/80-89 mm Hg in high-risk patients 1. The ESC also does not vary diagnostic BP categories by age 1.

Screening Recommendations

• Adults ≥18 years should be screened at least every 2 years if BP <120/80 mm Hg 1
• Annual screening is recommended for those with BP 120-139/80-89 mm Hg 1
• These screening intervals apply regardless of age 1

Key Takeaway for Clinical Practice

The "acceptable" or "normal" BP range does not change with age—it remains <120/80 mm Hg for all adults. 1 What changes with advancing age is the clinical approach to elevated BP, including treatment intensity, medication choices, and monitoring for adverse effects like orthostatic hypotension 2, 3. The notion that higher BP is "acceptable" in older adults is outdated; rather, treatment must be more carefully individualized in this population 2, 3.