Blood Pressure Classification and Measurement Guidelines

1. Classification Thresholds

• The American College of Cardiology/American Heart Association (AHA/ACC) 2025 guideline defines four office‑blood‑pressure categories: normal < 120/80 mmHg, elevated 120‑129/<80 mmHg, hypertension stage 1 130‑139/80‑89 mmHg, and hypertension stage 2 ≥ 140/≥ 90 mmHg. 1
• The European Society of Cardiology (ESC) 2024 guideline recommends simplifying terminology to “non‑elevated,” “elevated,” and “hypertension” for therapeutic decision‑making, while retaining thresholds essentially identical to the AHA/ACC values. 2

2. Office Measurement Protocol

• Diagnosis should be based on repeated office blood‑pressure measurements on ≥ two separate visits, except in cases of severe hypertension (stage 3 or high‑risk patients) where earlier confirmation is acceptable. 2
• At each visit, three readings are to be taken 1–2 minutes apart; if the first two readings differ by more than 10 mmHg, additional measurements are required. 2

3. Out‑of‑Office Confirmation

• When feasible, the diagnosis must be confirmed with ambulatory blood‑pressure monitoring (ABPM) and/or home self‑measurement (HBPM) to improve accuracy and guide treatment. 2

4. Immediate‑Action Blood‑Pressure Thresholds

• For office systolic/diastolic ≥ 160/100 mmHg:
  
  • If BP is 160‑179/100‑109 mmHg, confirm the reading as soon as possible (within 1 month), preferably using HBPM or ABPM. 2
  • If BP is ≥ 180/110 mmHg, an urgent evaluation to exclude hypertensive emergency is required. 2

5. Device Recommendations

• Devices lacking a cuff (e.g., smartwatch‑only sensors) should not be relied upon for accurate blood‑pressure measurement until validated for higher precision and reliability. 1

ACC/AHA 2025 Hypertension Classification and Diagnosis Guidelines

Blood Pressure Classification (Office Measurements)

• The 2025 ACC/AHA guideline defines four office‑based blood pressure categories: Normal < 120/80 mmHg, Elevated 120‑129/<80 mmHg, Stage 1 Hypertension 130‑139/80‑89 mmHg, and Stage 2 Hypertension ≥ 140/≥ 90 mmHg. When systolic and diastolic values fall into different categories, the patient is classified according to the higher category. 3

Out‑of‑Office Blood Pressure Thresholds

• For ambulatory monitoring, hypertension is diagnosed when the 24‑hour average ≥ 130/80 mmHg (lower than the office threshold). 3

Diagnostic Requirements

• A hypertension diagnosis requires the average of ≥ 2 careful readings obtained on ≥ 2 separate occasions; earlier confirmation is acceptable only in severe or high‑risk patients. 3

Epidemiology (Prevalence)

• Hypertension prevalence rises sharply with age, affecting ≈ 20 % of adults aged 18‑29 years and ≈ 84 % of those aged 75‑80 years. 3
• Among racial/ethnic groups, Non‑Hispanic Black adults have the highest prevalence at ≈ 57 %. 3