Hypertension and their stages
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Hypertension: blood pressure stages in adults
Blood pressure is written as systolic/diastolic in mmHg, for example, 130/85 mmHg. If the systolic and diastolic values fall in different categories, use the higher category.
ACC/AHA classification
| Category | Systolic BP | Diastolic BP |
|---|---|---|
| Normal | <120 | and <80 |
| Elevated BP | 120-129 | and <80 |
| Stage 1 hypertension | 130-139 | or 80-89 |
| Stage 2 hypertension | ≥140 | or ≥90 |
| Hypertensive crisis | >180 | and/or >120 |
A reading in the hypertensive crisis range should be repeated after a few minutes. If it remains that high, seek urgent medical advice. If there is chest pain, shortness of breath, weakness/numbness, visual change, confusion, or severe headache, seek emergency care immediately.
European/ESH grading system
| Category | Systolic BP | Diastolic BP |
|---|---|---|
| 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 hypertension | ≥140 | with <90 |
The difference is mainly diagnostic threshold: ACC/AHA calls 130/80 mmHg or above hypertension, whereas European grading generally defines hypertension as 140/90 mmHg or above. See the ESC blood-pressure classification.
Diagnosis should be based on the average of properly measured readings on at least two occasions, often confirmed with home or ambulatory BP monitoring, rather than one isolated high reading. The textbook source similarly describes classification in adults based on averages of repeated readings: Park's Textbook of Preventive and Social Medicine, Hypertension section.
What are the symptoms and complications of hypertension?
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Symptoms of hypertension
Most people with hypertension have no symptoms. It is often called a “silent” condition and is detected only when blood pressure is measured. Hypertension is usually asymptomatic until significant organ damage is developing or has occurred. Katzung's Basic and Clinical Pharmacology, 16th ed., “Blood pressure in adults.”
Some people, especially with very high or rapidly rising blood pressure, may have:
- Headache
- Dizziness
- Blurred vision or other visual disturbance
- Nosebleed
- Palpitations
- Shortness of breath
- Chest discomfort
- Fatigue or confusion
These symptoms are nonspecific. They cannot reliably diagnose hypertension, so regular blood-pressure measurement is needed. The CDC overview also emphasizes that high blood pressure commonly has no warning signs.
Complications of long-standing uncontrolled hypertension
Persistent high pressure damages blood vessels and target organs.
| Organ system | Major complications |
|---|---|
| Heart and blood vessels | Coronary artery disease, angina, heart attack, left ventricular hypertrophy, heart failure, atrial fibrillation, peripheral arterial disease, aortic aneurysm or dissection |
| Brain | Ischemic stroke, hemorrhagic stroke, transient ischemic attack, vascular cognitive impairment/dementia |
| Kidneys | Chronic kidney disease, protein in urine, progressive kidney failure |
| Eyes | Hypertensive retinopathy, retinal hemorrhages, optic-disc swelling in severe cases, visual impairment/loss |
| Sexual health | Erectile dysfunction; reduced sexual function can also occur in women |
| Pregnancy | Increased risk of pre-eclampsia, placental abruption, fetal growth restriction, and preterm birth |
The heart, brain, kidneys, and eyes are the main target organs affected by hypertension, as summarized by the American Heart Association.
Hypertensive emergency warning signs
If BP is over 180/120 mmHg, repeat it after a few minutes. Seek emergency care immediately if the elevated reading is accompanied by:
- Chest pain
- Severe shortness of breath
- Sudden weakness or numbness, especially on one side
- Difficulty speaking, confusion, or fainting
- Sudden visual loss/change
- Severe headache
- Severe back pain
These may indicate acute damage such as stroke, heart attack, acute heart failure, aortic dissection, or hypertensive encephalopathy.
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