Two major guidelines with different thresholds, which one applies to you?
The two main international systems give different classifications for the same reading. At 135/85 mmHg: AHA 2017 (USA) = Stage 1 Hypertension (medication may be recommended); ESC/ESH 2018 (UK/Europe) = High Normal (lifestyle changes only for most). UK NICE and BHS follow the European ESC/ESH approach, not the AHA.
ESC/ESH 2018 categories, UK, Europe, Australia, most of the world
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Optimal | < 120 | < 80 |
| Normal | 120-129 | 80-84 |
| High Normal | 130-139 | 85-89 |
| Grade 1 Hypertension | 140-159 | 90-99 |
| Grade 2 Hypertension | 160-179 | 100-109 |
| Grade 3 Hypertension | ≥ 180 | ≥ 110 |
| Isolated Systolic HT | ≥ 140 | < 90 |
| Hypotension | < 90 | < 60 |
AHA 2017 categories, United States
| Category | Systolic | Diastolic |
|---|---|---|
| Normal | < 120 | < 80 |
| Elevated | 120-129 | < 80 |
| Stage 1 High BP | 130-139 | 80-89 |
| Stage 2 High BP | ≥ 140 | ≥ 90 |
| Hypertensive Crisis | > 180 | > 120 |
UK measurement guidance (NICE / BHS)
- For diagnosis: if clinic reading > 140/90 mmHg, offer 24-hour ambulatory BP monitoring (ABPM) before diagnosing, this filters out white-coat hypertension
- Home monitoring: 2 readings in the morning (before medication), 2 in the evening, for 7 days; discard day 1, average the rest
- Use a validated upper-arm device; wrist monitors are less reliable
- 5 minutes of rest, no caffeine/exercise for 30 minutes before measurement
Informational only, thresholds per ESC/ESH 2018 (UK/Europe) and AHA 2017 (USA). Consult your GP for clinical interpretation and treatment decisions.