Criteria

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)[3]

Definitions were not specifically addressed in JNC 8, though the JNC-7 definitions were implicitly adopted. New thresholds for pharmacologic treatment were defined.

The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (2004)[1]

The categories are based on the average of two or more seated blood pressure (BP) measurements on two separate office visits.

  • Normal: <120/80 mmHg

  • Pre-hypertension: 120-139/80-89 mmHg

  • Hypertension: ≥140/90 mmHg

    • Stage 1: 140-159/90-99 mmHg

    • Stage 2: ≥160/100 mmHg

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults[5]

Blood pressure is categorized in 4 levels based on an average of two or more properly taken BP measurements on two or more occasions in a healthcare setting (office setting):

  • Normal BP: systolic BP <120 mmHg and diastolic BP <80 mmHg

  • Elevated BP: systolic BP 120-129 mmHg and diastolic BP <80 mmHg

  • Stage 1 hypertension: systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg

  • Stage 2 hypertension: systolic BP ≥140 mmHg or diastolic BP 90 mmHg

Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children[56]

Blood pressure is assessed using the following 4 approaches:

  • Automated office BP: a displayed mean systolic BP ≥135 mmHg or diastolic BP ≥85 mmHg is high.

  • Non-automated office BP: a mean systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg is high, and a systolic BP between 130 and 139 mmHg and/or a diastolic BP between 85 and 89 mmHg is high-normal.

  • Ambulatory BP monitoring: patients can be diagnosed as hypertensive if the mean awake systolic BP is ≥135 mmHg or the diastolic BP is ≥85 mmHg, or if the mean 24-hour systolic BP is ≥130 mmHg or the diastolic BP is ≥80 mmHg.

  • Home BP monitoring: patients can be diagnosed as hypertensive if the mean systolic BP is ≥135 mmHg or the diastolic BP is ≥85 mmHg. If the office BP measurement is high and the mean home BP is <135/85 mmHg, it is advisable to either repeat home monitoring to confirm the home BP is <135/85 mmHg or perform 24-hour ambulatory BP monitoring to confirm that the mean 24-hour ambulatory BP monitoring is <130/80 mmHg and the mean awake ambulatory BP monitoring is <135/85 mmHg before diagnosing white-coat hypertension.

2018 European Society of Cardiology/European Society of Hypertension guidelines for the management of arterial hypertension[2]

Cut-offs for the definition of hypertension for specific measurements are as follows.

Office BP

  • Optimal BP: systolic BP <120 mmHg and diastolic BP <80 mmHg

  • Normal BP: systolic BP 120-129 mmHg and/or diastolic BP 80-84 mmHg

  • High-normal BP: systolic BP 130-139 mmHg and/or diastolic BP 85-89 mmHg

  • Grade 1 hypertension: systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg

  • Grade 2 hypertension: systolic BP 160-179 mmHg and/or diastolic BP 100-109 mmHg

  • Grade 3 hypertension: systolic BP ≥180 mmHg and/or diastolic BP ≥110 mmHg

  • Isolated systolic hypertension: systolic BP ≥140 mmHg and diastolic BP <90 mmHg

Ambulatory BP

  • Systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg for 24-hour BP

  • Systolic BP ≥135 and/or diastolic BP ≥85 mmHg for daytime ambulatory BP and home BP

  • Systolic BP ≥120 and/or diastolic BP ≥70 mmHg for nighttime BP

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