Diagnostic Criteria for Hypertension

Blood Pressure Classification

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines define normal blood pressure as <120/80 mm Hg 1, 4
Elevated blood pressure is defined as 120-129 mm Hg systolic and <80 mm Hg diastolic 4, 5
Stage 1 hypertension is defined as 130-139 mm Hg systolic or 80-89 mm Hg diastolic 1, 4, 3
Stage 2 hypertension is defined as ≥140 mm Hg systolic or ≥90 mm Hg diastolic 4, 3

Blood pressure should be measured at every routine clinical visit 5
Diagnosis should be based on an average of ≥2 readings obtained on ≥2 separate occasions 4, 5
Patients should be seated with no conversation during measurement, empty bladder, correct cuff size on bare arm, arm supported at heart level, legs uncrossed, and back and feet supported 3, 5
Patients should be allowed 5 minutes of rest before measurement 5

Home blood pressure monitoring (HBPM) or ambulatory blood pressure monitoring (ABPM) should be used to confirm the diagnosis and detect white coat hypertension or masked hypertension 4, 5, 3
All people with hypertension should be counseled to monitor their blood pressure at home after appropriate education 5
White coat hypertension is defined as office BP ≥130/80 mm Hg but out-of-office BP <130/80 mm Hg 3
Masked hypertension is defined as normal office BP but high out-of-office BP 4

In patients with diabetes, hypertension is defined using the same threshold of ≥130/80 mm Hg 5
For elderly patients (≥65 years), the diagnostic criteria remain the same, but treatment targets may be individualized based on frailty and comorbidities 6
In patients with cardiovascular disease and BP ≥180/110 mm Hg, it is reasonable to diagnose hypertension at a single visit 5

Stage 1 hypertension (130-139/80-89 mm Hg) carries approximately a 2-fold increase in cardiovascular disease risk compared to normal BP 4
Most measurement errors bias readings upward, potentially leading to over-diagnosis and over-treatment 1, 3
The reclassification of BP from the previous definition (≥140/90 mm Hg) to the current one (≥130/80 mm Hg) resulted in an estimated 14% increase in hypertension prevalence in the US, but only a 1.9% increase in adults requiring antihypertensive drug therapy 4