Normal Blood Pressure Ranges for Adults by Age
Normal blood pressure for all adults aged 18 years and older is defined as systolic <120 mm Hg AND diastolic <80 mm Hg, regardless of age. 1, 2
Standard Blood Pressure Categories for Adults
The 2017 ACC/AHA guidelines establish the following universal classification system that applies to all adults ≥18 years:
- Normal: <120/<80 mm Hg 1, 2
- Elevated: 120-129/<80 mm Hg 1, 2
- Stage 1 Hypertension: 130-139/80-89 mm Hg 1, 2
- Stage 2 Hypertension: ≥140/≥90 mm Hg 1, 2
When systolic and diastolic values fall into different categories, the higher category determines classification. 1, 2
Age-Related Blood Pressure Patterns
While the definition of normal blood pressure remains constant across all adult ages, several important age-related considerations exist:
Prevalence of Normal Blood Pressure by Age
The proportion of adults maintaining normal blood pressure decreases dramatically with age:
- Ages 20-44: 57.8% have normal BP 3
- Ages 45-64: 25.3% have normal BP 3
- Ages 65-74: 11.2% have normal BP 3
- Ages ≥75: 5.0% have normal BP 3
Cardiovascular Risk Across the Blood Pressure Spectrum
The relationship between blood pressure and cardiovascular risk is continuous and graded, beginning at 115/75 mm Hg. 1 For every 20 mm Hg increase in systolic pressure or 10 mm Hg increase in diastolic pressure above 115/75 mm Hg, the risk of death from stroke, heart disease, or other vascular disease doubles. 1
Even blood pressure in the "elevated" range (120-129/<80 mm Hg) carries increased cardiovascular risk and warrants lifestyle modifications to prevent progression to hypertension. 2
Special Considerations for Older Adults (≥65 Years)
Treatment Thresholds and Targets
For older adults ≥65 years, the treatment approach differs from the diagnostic definition:
- Normal BP definition remains <120/<80 mm Hg 1, 4
- Treatment threshold: Initiate therapy at SBP ≥130 mm Hg 4, 5
- Treatment target: <130/80 mm Hg for ambulatory, community-dwelling adults ≥65 years 4
- For adults ≥80 years: Target SBP <130 mm Hg if tolerated, though 140-145 mm Hg is acceptable in some guidelines 4, 6
Isolated Systolic Hypertension
Isolated systolic hypertension (SBP ≥140 mm Hg with DBP <90 mm Hg) becomes the predominant form of hypertension in older adults as systolic pressure rises and diastolic pressure falls with age. 1, 4 This pattern reflects arterial stiffening and increased pulse pressure.
Proper Measurement Technique
Blood pressure classification must be based on the average of ≥2 properly measured, seated readings obtained on ≥2 separate occasions. 1, 2 A single elevated reading is insufficient for diagnosis. 2
Key measurement requirements:
- Patient seated quietly for ≥5 minutes 2
- Feet flat on floor, arm supported at heart level 2
- Avoid caffeine, exercise, and smoking for ≥30 minutes before measurement 2
- Use appropriately sized cuff (bladder covering ≥80% of arm circumference) 2
Common Pitfalls to Avoid
Failing to use proper measurement technique leads to inaccurate readings and inappropriate treatment decisions. 4 White-coat hypertension affects 15-20% of people with stage 1 hypertension, where blood pressure is elevated only in the presence of healthcare workers. 1
Do not assume that "normal for age" means accepting higher blood pressure in older adults. The definition of normal blood pressure (<120/<80 mm Hg) does not change with age, though the prevalence of achieving this target decreases. 1, 3 Randomized trials demonstrate that intensive blood pressure lowering safely reduces cardiovascular events in adults >65, >75, and >80 years of age. 4
For older adults with high comorbidity burden and limited life expectancy, clinical judgment and patient preference should guide intensity of blood pressure control, but the baseline definition of normal remains unchanged. 4