Hypertention classification stndart latest

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Here is the latest hypertension classification according to the major international guidelines, as presented in current medical textbooks:

Hypertension Classification — Current Guidelines

1. ACC/AHA 2017 (USA) — Most Widely Used

Category	Systolic (mm Hg)		Diastolic (mm Hg)
Normal	< 120	and	< 80
Elevated	120–129	and	< 80
Stage 1 Hypertension	130–139	or	80–89
Stage 2 Hypertension	≥ 140	or	≥ 90
Hypertensive Crisis	> 180	and/or	> 120

Key change from JNC 7: The threshold for hypertension was lowered to 130/80 mm Hg, which raised adult prevalence in the US to ~46%. The term "prehypertension" was eliminated.

2. ESC/ESH 2018 (Europe)

Office BP Category	Systolic (mm Hg)	Diastolic (mm Hg)
Optimal	< 120	and < 80
Normal	120–129	and/or 80–84
High-Normal	130–139	and/or 85–89
Grade 1 Hypertension	140–159	and/or 90–99
Grade 2 Hypertension	160–179	and/or 100–109
Grade 3 Hypertension	≥ 180	and/or ≥ 110
Isolated Systolic HTN	≥ 140	and < 90

Hypertension diagnosis threshold for office BP remains ≥ 140/90 mm Hg. Out-of-office thresholds differ (ABPM daytime ≥ 135/85; 24-hr ≥ 130/80; home BP ≥ 135/85).

3. ISH 2020 (International Society of Hypertension — Global)

Category	Systolic (mm Hg)		Diastolic (mm Hg)
Normal	< 130	and	< 85
High-Normal	130–139	and/or	85–89
Grade 1 Hypertension	140–159	and/or	90–99
Grade 2 Hypertension	≥ 160	and/or	≥ 100

Designed for global applicability, including low/middle-income countries. Uses a 2-grade system. Diagnosis threshold is ≥ 140/90 mm Hg.

4. JNC 7 (2003) — Historical Reference

Classification	SBP (mm Hg)		DBP (mm Hg)
Normal	< 120	and	< 80
Prehypertension	120–139	or	80–89
Stage 1 HTN	140–159	or	90–99
Stage 2 HTN	≥ 160	or	≥ 100

Key Comparison: ACC/AHA 2017 vs ESC/ESH 2018

Feature	ACC/AHA 2017	ESC/ESH 2018
HTN diagnosis threshold	≥ 130/80	≥ 140/90
Staging system	2 stages	3 grades
"Prehypertension" term	Eliminated	Not used (uses "high-normal")
CV risk in classification	Incorporated	Incorporated

Special Contexts

Hypertensive Urgency: SBP > 180 and/or DBP > 120, no acute end-organ damage
Hypertensive Emergency: Same BP levels with acute end-organ damage (AKI, encephalopathy, aortic dissection, etc.)
White Coat HTN: Elevated office BP, normal out-of-office BP
Masked HTN: Normal office BP, elevated out-of-office BP
Resistant HTN: Uncontrolled despite ≥ 3 drugs at optimal doses (including a diuretic)

Sources:

Comprehensive Clinical Nephrology, 7th Edition — Tables 34.2, 34.3, 34.4
Fuster and Hurst's The Heart, 15th Edition
Harrison's Principles of Internal Medicine, 22nd Edition (2025)

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