Blood pressure classification thresholds: ACC/AHA versus ESC/ESH

What it is

The same BP value is named differently by three classifications, so the label depends on which one is in use.

Previous classification:

• Normal BP: SBP <120 mmHg and DBP <80 mmHg
• Prehypertension: SBP 120-139 mmHg or DBP 80-89 mmHg
• Hypertension Stage 1: SBP 140-159 mmHg or DBP 90-99 mmHg
• Hypertension Stage 2: SBP 160 mmHg or above, or DBP 100 mmHg or above

2017 ACC/AHA Guidelines:

• Normal BP: SBP <120 mmHg and DBP <80 mmHg
• Elevated BP: SBP 120-129 mmHg and DBP <80 mmHg
• Hypertension Stage 1: SBP 130-139 mmHg or DBP 80-89 mmHg
• Hypertension Stage 2: SBP 140 mmHg or above, or DBP 90 mmHg or above

2018 ESC/ESH Guidelines:

• Optimal BP: SBP <120 mmHg and DBP <80 mmHg
• Normal BP: SBP 120-129 mmHg and/or DBP 80-84 mmHg
• High Normal BP: SBP 130-139 mmHg and/or DBP 85-89 mmHg
• Grade 1 Hypertension: SBP 140-159 mmHg and/or DBP 90-99 mmHg
• Grade 2 Hypertension: SBP 160-179 mmHg and/or DBP 100-109 mmHg
• Grade 3 Hypertension: SBP 180 mmHg or above and/or DBP 110 mmHg or above

The band where the two guidelines part is SBP 130-139 mmHg: ACC/AHA already calls it Hypertension Stage 1, while ESC/ESH still calls it High Normal BP. On DBP the two do not run together: ACC/AHA Hypertension Stage 1 is DBP 80-89 mmHg, and that band is not one band in ESC/ESH, where DBP 80-84 mmHg is Normal BP and DBP 85-89 mmHg is High Normal BP. And ACC/AHA Stage 2 begins at 140 over 90, which is where ESC/ESH Grade 1 Hypertension begins.

In the definition of HTN according to the BMJ, it is more than 140/ 90.