Hypertension is a common disorder that affects a large proportion of the community. It is usually asymptomatic and is detected on routine exam or after the occurrence of a complication such as heart attack or stroke.[1]
The 2025 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults defines hypertension as any systolic blood pressure measurement of ≥130 mmHg or any diastolic blood pressure measurement of ≥80 mmHg.[2] AHA/ACC blood pressure categories are defined as follows:
- Elevated blood pressure: systolic blood pressure of 120-129 mmHg and diastolic blood pressure of <80 mmHg
- Stage 1 hypertension: systolic blood pressure of 130-139 mmHg or diastolic blood pressure of 80-89 mmHg
- Stage 2 hypertension: systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg
The AHA/ACC guidelines were mainly based on the results of the SPRINT trial, which investigated intensive or standard hypertension treatment in people with a systolic blood pressure of ≥130 mmHg with an increased cardiovascular risk (but without diabetes).[3]
European guideline blood pressure categories are defined as follows:[4]
- Elevated blood pressure: office systolic blood pressure 120-139 mmHg or office diastolic blood pressure 70-89 mmHg
- Hypertension: office systolic blood pressure ≥140 mmHg or office diastolic blood pressure ≥90 mmHg.
For the diagnosis of elevated blood pressure or hypertension to be made, the European guidelines recommend confirmation with out-of-office measurements or at least one repeat office measurement at a subsequent visit.[4] Isolated systolic hypertension is defined as a systolic blood pressure ≥140 mmHg, with a diastolic blood pressure <90 mmHg.[4]
The UK National Institute for Health and Care Excellence states that a diagnosis of hypertension is confirmed in those with:[5]
- a clinic blood pressure of ≥140/90 mmHg, and
- daytime ambulatory blood pressure monitoring average or home blood pressure monitoring average of ≥135/85 mmHg.
Although different studies have used a variety of cut-off points for the diagnosis of hypertension in the community, any blood pressure >120 mmHg systolic is associated with an increased cardiovascular risk. The importance of hypertension is its relation to other cardiovascular risk factors and consequent overall cardiovascular risk.
The AHA/ACC defines resistant hypertension as:[2]
- Blood pressure above goal (i.e., >130/80 mmHg) despite the concurrent use of at least 3 antihypertensive agents with complementary mechanisms of action (including a diuretic) at maximum or maximally tolerated doses.
- Blood pressure at goal but requiring 4 or more antihypertensive agents.
The diagnosis of resistant hypertension requires the exclusion of white-coat hypertension and poor adherence with antihypertensive medication.[2]
This topic addresses the evaluation of hypertension in adults.
