Definition of hypertension
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Here is a comprehensive definition of hypertension drawn from authoritative medical textbooks:
Definition of Hypertension
Core Concept
Hypertension (HTN) is a condition of persistently elevated blood pressure (BP). Because BP follows a continuous distribution in the population and cardiovascular (CV) risk rises progressively across the entire BP range — even from as low as 115/75 mmHg — any numerical definition is inherently arbitrary. Risk of death from heart disease and stroke increases progressively and linearly with rising BP in all age groups from 40–89 years; an increase of 20 mmHg in systolic BP (SBP) or 10 mmHg in diastolic BP (DBP) is associated with a doubling of CV/stroke mortality. — Comprehensive Clinical Nephrology, 7th Ed.
Current ACC/AHA 2017 Classification (Adults ≥18 years)
The American College of Cardiology (ACC) and American Heart Association (AHA) lowered the diagnostic threshold for hypertension from 140/90 to 130/80 mmHg in 2017, reflecting growing awareness of long-term CV risk at modest BP elevations.
| BP Category | Systolic (mmHg) | Diastolic (mmHg) | |
|---|---|---|---|
| Normal | < 120 | and | < 80 |
| Elevated BP | 120–129 | and | < 80 |
| Stage I HTN | 130–139 | or | 80–89 |
| Stage II HTN | ≥ 140 | or | ≥ 90 |
(Previously under JNC 7, 120–139/80–89 was termed "prehypertension" and HTN started at ≥140/90 mmHg)
— Rosen's Emergency Medicine, 9th Ed.; Harrison's Principles of Internal Medicine, 22nd Ed.
Diagnostic Requirements
- BP classification requires accurate measurement and the average of ≥2 readings on ≥2 separate occasions
- When SBP and DBP fall in different categories, the higher category is used
- Diagnosis should be confirmed with ambulatory BP monitoring (ABPM) or home BP measurements to exclude:
- White coat hypertension — office BP meets HTN criteria but out-of-office BP is normal (prevalence ~15–25%)
- Masked hypertension — office BP is normal but out-of-office BP meets HTN criteria (prevalence ~15–25%)
- ABPM thresholds are lower than clinic thresholds: clinic 130/80 corresponds to ABPM ~125/75 mmHg
— Harrison's Principles of Internal Medicine, 22nd Ed.; Rosen's Emergency Medicine, 9th Ed.
In Children and Adolescents (<13 years)
Hypertension is defined as an average SBP or DBP at or above the 95th percentile for age, sex, and height on three separate occasions, or SBP ≥130 / DBP ≥80 mmHg. — Harrison's, 22nd Ed.
European vs. American Thresholds
The 2018 ESC/ESH (European) guidelines retain the traditional threshold of ≥140/90 mmHg for the diagnosis of hypertension, classifying 130–139/85–89 as "high-normal" BP — a meaningful difference from the ACC/AHA approach. — Comprehensive Clinical Nephrology, 7th Ed.
Key Takeaway
Hypertension is defined as a sustained elevation of blood pressure at or above 130/80 mmHg (ACC/AHA 2017) or 140/90 mmHg (ESC/ESH 2018), confirmed by accurate and repeated measurements, associated with significantly increased risk of cardiovascular disease, stroke, and end-organ damage.
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