Degrees of arterial hypertension: norms, classification, risks and treatment

Arterial hypertension is a condition in which the pressure in the arteries is persistently elevated. The World Health Organization defines hypertension as a pressure of 140 over 90 millimeters of mercury or higher, if such values are confirmed by repeated measurements rather than a single random number. [1]

The word "grade" typically describes the level of blood pressure, not the severity of the disease as a whole. For example, one person's blood pressure of 150/95 mmHg may be accompanied by diabetes, chronic kidney disease, and high cardiovascular risk, while in another it may be the only identified risk factor; the grade may be technically the same, but the prognosis and treatment will be different. [2]

In the European tradition, 3 degrees of arterial hypertension are most often used: degree 1 - from 140 to 159 or from 90 to 99 millimeters of mercury, degree 2 - from 160 to 179 or from 100 to 109 millimeters of mercury, degree 3 - 180 or higher or 110 or higher millimeters of mercury. The European Society of Hypertension 2023 retained these degrees, while the European Society of Cardiology 2024 proposed a simpler scheme: not elevated pressure, elevated pressure and hypertension. [3] [4]

The American classification differs: in the recommendations of the American Heart Association and the American College of Cardiology, hypertension begins at 130 over 80 millimeters of mercury, while values of 130-139 or 80-89 are considered stage 1. Therefore, the same patient may receive different definitions in the American and European systems, and this is not an error, but a difference in classification thresholds. [5]

The main practical conclusion: blood pressure level helps quickly understand the initial level of risk, but diagnosis and treatment cannot be based on a single number alone. Proper measurement technique, repeated measurements, home or daily monitoring, assessment of damage to the heart, kidneys, blood vessels, the fundus, and overall cardiovascular risk are necessary. [6]

Concept	What does it mean?	Why is it important?
Blood pressure	Blood pressure on the arterial walls	The higher the pressure and the longer it lasts, the higher the risk of complications.
Systolic pressure	The top number is the pressure when the heart contracts.	Strongly associated with the risk of stroke and heart failure
Diastolic pressure	The bottom number is the pressure between heartbeats.	Especially important for young and middle-aged people
Degree of hypertension	Pressure increase range	Helps to initially assess the severity of the increase
Cardiovascular risk	Risk of heart attack, stroke and other complications	Determines the urgency and intensity of treatment
Target organ damage	Changes in the heart, kidneys, blood vessels, and retina	Increases risk even with moderate increases in pressure

Source for the table: Current guidelines emphasize that pressure should be considered as a continuous risk factor, and not just as a formal category. [7]

Code according to ICD 10 and ICD 11

In the International Classification of Diseases, 10th revision, essential, or primary, arterial hypertension is coded as I10. If high blood pressure has already led to damage to the heart, kidneys, or both the heart and kidneys, other groups are used: I11, I12, and I13; secondary hypertension caused by another disease is classified as I15. [8]

In the International Classification of Diseases, 11th revision, essential hypertension is coded as BA00. Within this section, combined systolic and diastolic hypertension, isolated diastolic hypertension, isolated systolic hypertension, other specified forms, and unspecified essential hypertension are separately distinguished. [9]

It's important to understand: The International Classification of Diseases codes diagnosis and complications, but doesn't always directly reflect "Grade 1," "Grade 2," or "Grade 3" in the code itself. Grade is typically recorded in the clinical diagnosis using words and pressure numbers, and the code is selected based on the type of hypertension and the presence of organ damage. [10]

If a person has chronic kidney disease, heart failure, left ventricular hypertrophy, a history of stroke, or other complications, the code "primary hypertension" alone may not be sufficient to provide a complete medical picture. In such cases, the physician additionally codes for organ damage and associated conditions. [11]

Separate diagnostic approaches and codes are used for pregnancy, children, endocrine diseases, renal artery disease, and other secondary causes of high blood pressure. Therefore, the definition of "stage 2 hypertension" without specifying the cause, age, pregnancy, and organ damage may be incomplete. [12]

Clinical situation	International Classification of Diseases, 10th revision	International Classification of Diseases, 11th revision	Comment
Primary arterial hypertension	I10	BA00	The most common variant in adults
Hypertensive heart disease	I11	code hypertension and heart disease according to the classification structure	Important for hypertrophy and heart failure
Hypertensive kidney disease	I12	encode hypertension and kidney disease	Important for chronic kidney disease
Hypertensive heart and kidney disease	I13	combined state coding	Indicates a high risk
Secondary hypertension	I15	the code depends on the reason	We need to look for the underlying disease.
Isolated systolic hypertension	In the International Classification of Diseases, 10th revision, it is usually coded by the type of hypertension and context	BA00.2	Often found in older people
Hypertensive crisis	I16 in some national versions	coding depends on complications	It is important to distinguish between an emergency and simply a high number.

Source for the table: the coding structure shows that in hypertension it is important to indicate not only the increase in pressure, but also damage to the heart, kidneys, pregnancy, secondary causes and complications. [13]

Modern classifications: why do the numbers differ in different recommendations?

The World Health Organization uses a classic diagnostic threshold: hypertension is diagnosed if, when measured on different days, systolic pressure is 140 mmHg or higher and either diastolic pressure is 90 mmHg or higher. This approach is useful for global health and data comparisons across countries. [14]

The 2023 European Society of Hypertension guidelines retained the traditional scale of levels: optimal, normal, high-normal, and three stages of hypertension. This system helps physicians more accurately describe blood pressure levels above 140/90 mmHg and distinguish moderate from severe elevations. [15]

The 2024 European Society of Cardiology simplified the classification and introduced the category "high blood pressure" for office readings of 120-139 or 70-89 mmHg, leaving hypertension at 140/90 mmHg and above. This reflects the modern idea that cardiovascular risk increases gradually, even before a formal diagnosis of hypertension. [16]

The 2025 US guidelines maintain a lower threshold for diagnosis: stage 1 begins at 130-139 or 80-89 mmHg, and stage 2 begins at 140 or 90 mmHg. However, the treatment target for most adults in the US system remains below 130 over 80 mmHg. [17]

Therefore, when reading medical articles, it is important to look at the system being used. If it says "grade 1," it usually refers to the European scale of 140-159 or 90-99; if it says "stage 1" in an American context, it is 130-139 or 80-89. [18]

System	How does hypertension begin?	How to describe levels
World Health Organization	140 x 90 millimeters of mercury or higher	Practical global diagnostic threshold
European Society of Hypertension 2023	140 x 90 millimeters of mercury or higher	1, 2 and 3 degrees
European Society of Cardiology 2024	140 x 90 millimeters of mercury or higher	Low or high blood pressure, hypertension
American Heart Association and American College of Cardiology 2025	130 by 80 millimeters of mercury or higher	Normal, elevated, stage 1, stage 2
NICE, UK	140 to 90 in the clinic, confirmed 135 to 85 outside the clinic	1, 2 and severe hypertension in clinical practice

Source for table: Differences between European, British and American thresholds are due to different classification logics, but all systems emphasize the need for confirmation of diagnosis and assessment of overall risk. [19]

Normal, elevated and high normal blood pressure: early risk zone

Blood pressure below 120/70 mmHg is considered mildly elevated in the new European 2024 guidelines. This doesn't mean a person can ignore preventative measures: blood pressure changes with age, body weight, diet, physical activity, stress, sleep, and medications. [20]

A range of 120-139 or 70-89 millimeters of mercury is called "high blood pressure" in the 2024 European guidelines. This isn't yet classic hypertension, but it's a sign that the risk is rising and lifestyle interventions are needed, especially if you're overweight, have diabetes, chronic kidney disease, smoke, or have a family history of early cardiovascular events. [21]

In older European systems, readings of 130-139 or 85-89 mmHg were often referred to as "high normal pressure." In the American system, 130-139 or 80-89 mmHg already corresponds to stage 1 hypertension, so the same range may sound more lenient or strict depending on the country and recommendations. [22]

The main mistake in this zone is waiting for blood pressure to "rise" to 160 or 180 millimeters of mercury. Modern recommendations increasingly take into account the cumulative effects of blood pressure over the years: even moderately elevated blood pressure, if sustained for a long time, increases the risk of stroke, heart attack, heart failure, kidney damage, and dementia. [23]

At this stage, lifestyle modifications are typically initiated: reducing salt intake, weight control, regular physical activity, quitting smoking, limiting alcohol, improving sleep, and treating sleep apnea if suspected. In people with high cardiovascular risk, drug treatment may be considered earlier, even if blood pressure has not reached the classical European hypertension level. [24]

Pressure range in the doctor's office	European Logic 2024	Practical significance
Below 120 and below 70	Non-elevated pressure	Maintain a healthy lifestyle
120-129 or 70-79	High blood pressure	Monitor more often, strengthen prevention
130-139 or 80-89	High blood pressure, stage 1 in the American system	Assess your overall risk and actively change your lifestyle
140 and above or 90 and above	Arterial hypertension	Confirmation of diagnosis and treatment plan
180 and above or 110-120 and above	A tough promotion	Rule out emergency conditions and organ damage

Source for the table: The European Society of Cardiology 2024 introduced a category of high blood pressure of 120-139 or 70-89 millimeters of mercury, while maintaining hypertension from 140 to 90 millimeters of mercury. [25]

Stage 1 arterial hypertension

Stage 1 arterial hypertension in the European classification is defined as an office systolic pressure of 140 to 159 mmHg and a diastolic pressure of 90 to 99 mmHg. If the upper and lower numbers fall into different categories, the higher risk category is typically used. [26]

This stage is often asymptomatic. The World Health Organization emphasizes that most people with high blood pressure experience no symptoms, and the only reliable way to detect it is by measuring their blood pressure. Therefore, the absence of headaches, tinnitus, or palpitations does not mean the blood pressure is safe. [27]

At stage 1, the main goal is to confirm that the blood pressure is indeed persistently elevated. NICE recommends that if clinical blood pressure ranges from 140 over 90 to 180 over 120 mmHg, the diagnosis be confirmed by ambulatory 24-hour monitoring, or, if this is not possible, by home monitoring. [28]

Treatment strategy depends on the overall risk. If the person is young, without organ damage, and at low cardiovascular risk, the doctor may begin with intensive lifestyle changes and monitoring; if the person has diabetes, chronic kidney disease, cardiovascular disease, target organ damage, or is at high risk, medications are started earlier. [29]

It's important not to consider stage 1 "almost normal." Even moderately elevated blood pressure, if it persists for years, increases the strain on blood vessels, the heart, the brain, and the kidneys; this is why modern guidelines increasingly emphasize early detection and long-term risk reduction. [30]

Sign	Stage 1 arterial hypertension
Office pressure	140-159 or 90-99 millimeters of mercury
Common symptoms	Often absent
The main step	Confirm the diagnosis outside the doctor's office
What to check	Cardiovascular risk, kidneys, heart, retina, urine analysis
Treatment	Lifestyle, medications by risk
The main mistake	Thinking it's "no big deal" if there are no symptoms

Source for the table: The European classification distinguishes grade 1 from 140 to 90 millimetres of mercury, and NICE emphasizes the need to confirm the diagnosis outside the clinic. [31]

Stage 2 arterial hypertension

Stage 2 arterial hypertension, according to the European classification, is defined as pressure from 160 to 179 mmHg systolic or 100 to 109 mmHg diastolic. This is a significant increase, at which the risk of organ damage and the need for drug treatment are usually higher than at stage 1. [32]

At this stage, symptoms may still be absent. This is one of the reasons why hypertension is called a "silent" risk factor: the blood vessels, heart, kidneys, and brain are damaged gradually, and the person may feel relatively normal until the first complication occurs. [33]

At stage 2, it's important not only to reduce blood pressure but also to quickly assess target organ damage. NICE recommends that all people with hypertension have their urine tested for albumin and blood, blood tested for glycated hemoglobin, electrolytes, creatinine, estimated glomerular filtration rate, total cholesterol, and high-density lipoprotein cholesterol, a fundus examination, and an electrocardiogram. [34]

European and American approaches more often use combination drug therapy for higher blood pressure levels, as a single drug does not always sufficiently reduce blood pressure. A review of the differences between the recommendations of the European Society of Hypertension and the American Heart Association indicates that both systems use the main drug classes and increasingly support combinations to improve control. [35]

At stage 2, home blood pressure measurement is especially important. It helps distinguish true persistent hypertension from the "white coat" effect, monitor morning and evening readings, assess treatment response, and improve patient adherence. [36]

Sign	Stage 2 arterial hypertension
Office pressure	160-179 or 100-109 millimeters of mercury
Risk	Usually higher than at grade 1
Symptoms	May be absent
Examination	It is necessary to evaluate the heart, kidneys, blood vessels, eyes, and overall risk
Treatment	Drug therapy is often required, sometimes a combination
Control	Home or daily measurement helps manage treatment

Source for table: Current guidelines associate higher blood pressure levels with the need for active risk assessment, organ damage, and more intensive treatment. [37]

Stage 3 arterial hypertension and severe high blood pressure

Stage 3 hypertension in the European classification is defined as a systolic pressure of 180 mmHg or higher and a diastolic pressure of 110 mmHg or higher. This is a serious level of elevation, at which the risk of complications increases significantly, especially if such values are repeated or accompanied by symptoms. [38]

Very high blood pressure can cause severe headache, chest pain, shortness of breath, nausea, vomiting, blurred vision, confusion, anxiety, nosebleeds, and irregular heartbeat. The World Health Organization recommends that if blood pressure is typically 180 over 120 millimeters of mercury or higher and these symptoms occur, seek immediate medical attention. [39]

It's important to distinguish between a simply high number and a hypertensive emergency with organ damage. If the pressure is very high but there is no chest pain, shortness of breath, neurological symptoms, visual impairment, confusion, pulmonary edema, acute renal failure, or other signs of organ damage, the management may be less aggressive but still requires urgent medical evaluation. [40]

If high blood pressure is accompanied by signs of stroke, myocardial infarction, acute heart failure, aortic dissection, seizures, encephalopathy, acute renal failure, or retinal hemorrhage, this is no longer a situation for home blood pressure reduction. This condition requires emergency care and monitored treatment. [41]

Rapidly lowering blood pressure on your own with large doses of medication is dangerous. A too-rapid drop in blood pressure can impair blood flow to the brain, heart, and kidneys, especially in older people and patients with long-standing hypertension. [42]

Situation	What could this mean?	Tactics
180 and above or 110 and above without symptoms	Severe hypertension, high risk	Prompt medical evaluation, but not abrupt self-medication
180 to 120 or higher plus chest pain	Possible damage to the heart or aorta	Immediate assistance
Very high blood pressure plus arm weakness, speech impairment	Possible stroke	Immediate assistance
Very high blood pressure plus shortness of breath	Possible heart failure or pulmonary edema	Immediate assistance
Very high blood pressure plus confusion, seizures	Possible hypertensive encephalopathy	Immediate assistance
Very high blood pressure plus vomiting and blurred vision	Possible brain or retinal damage	Immediate assistance

Source for the table: The World Health Organization lists symptoms in which very high blood pressure requires immediate medical attention. [43]

Isolated systolic and isolated diastolic hypertension

Isolated systolic hypertension means that the upper pressure is elevated, while the lower pressure may be normal or relatively low. This variant is especially common in older people due to age-related stiffening of large arteries, but can also occur in younger people with high sympathetic activity, heart valve disease, and other conditions. [44]

Isolated diastolic hypertension means that the lower pressure is elevated, while the upper pressure does not reach the hypertensive range. In the International Classification of Diseases, 11th revision, it is separately classified as BA00.1, emphasizing the clinical importance of not only the upper number, but also the lower one. [45]

In older people, isolated systolic hypertension is particularly important because high systolic pressure is associated with a risk of stroke, heart failure, and kidney damage. NICE recommends that people with isolated systolic hypertension, when the systolic pressure is 160 mmHg or higher, be offered the same treatment as people with elevated systolic pressure. [46]

If the difference between upper and lower pressure is large, it's important to evaluate not only the degree but also the overall condition of the blood vessels, heart valves, anemia, thyroid disease, and other causes. Elderly and fragile patients should be treated with particular caution to avoid dizziness, falls, and severe orthostatic hypotension. [47]

If you experience dizziness when standing, falls, or weakness, your blood pressure should be measured not only while sitting, but also after standing. NICE recommends that if symptoms of postural hypotension are present, your blood pressure should be measured while lying down or sitting, and then again after standing for at least 1 minute. [48]

Option	What does it look like?	Why is it important?
Isolated systolic hypertension	The upper pressure is high, the lower pressure is not elevated.	Often seen in the elderly, associated with stiffness of the arteries
Isolated diastolic hypertension	The lower pressure is high, the upper pressure is not elevated.	Important for young and middle-aged people
Combined hypertension	Both indicators are increased	The most common option
High pulse pressure	Large difference between upper and lower pressure	May reflect vascular stiffness
Orthostatic pressure drop	Blood pressure drops when standing up	Risk of falls and injuries
The pressure is different on the arms.	A difference of more than 15 millimeters of mercury requires re-checking.	Next, measure on the arm with the higher pressure.

Source for table: NICE recommends that interarm difference, postural hypotension and isolated systolic hypertension be taken into account when diagnosing and treating blood pressure. [49]

How to correctly confirm the degree of arterial hypertension

A single measurement is not sufficient except in obvious emergency situations. Blood pressure is affected by stress, pain, caffeine, smoking, physical activity, conversation, cuff size, arm position, room temperature, and how long the person has been sitting before the measurement. [50]

NICE recommends that if hypertension is suspected, blood pressure should be measured in both arms and, if the difference is greater than 15 mmHg, the measurement should be repeated; if the difference persists, further measurements should be taken in the arm with the higher pressure. This reduces the risk of underestimating blood pressure. [51]

If the clinical pressure is 140 over 90 mmHg or higher, a second measurement is taken during the consultation, and if there is a significant difference, a third one; the lower of the last two measurements is used for the record. This approach reduces the influence of a random surge. [52]

To confirm the diagnosis, NICE prefers ambulatory 24-hour monitoring, and if this is not possible or poorly tolerated, home monitoring. Home monitoring involves taking two consecutive measurements at least 1 minute apart, twice daily, preferably morning and evening, for at least 4 days, preferably 7 days; the first day is discarded and the average of the remaining measurements is calculated. [53]

The NICE clinical diagnosis of hypertension is confirmed by an office blood pressure of 140/90 mmHg or higher and an average daytime ambulatory or home blood pressure of 135/85 mmHg or higher. This explains why home blood pressure thresholds are typically approximately 5 mmHg lower than office blood pressure thresholds.[54]

Stage	How to do it	For what
Preparation	Sit quietly, don't talk, hand supported	Reduce random error
First assessment	Measure on both arms	Find the arm with higher pressure
Replay in the office	Take 2-3 measurements	Reduce the impact of random bursts
Home control	2 measurements in the morning and evening for 4-7 days	Confirm the sustainability of the increase
Daily monitoring	Automatic measurements during the day and night	Identify nocturnal hypertension and the white coat effect
Interpretation	Compare office and off-site thresholds	Do not overestimate or underestimate the diagnosis

Source for table: NICE details the measurement technique, confirmation of diagnosis by ambulatory or home monitoring, and different thresholds for office and out-of-office measurements. [55]

Blood pressure and cardiovascular risk: Why they are not the same thing

Blood pressure indicates how high the numbers are, but it doesn't fully answer the question of how close a person is to a heart attack, stroke, heart failure, or kidney failure. Age, gender, smoking, cholesterol, diabetes, chronic kidney disease, family history, body weight, physical activity, and existing cardiovascular diseases must be taken into account to make a prognosis. [56]

European and American guidelines emphasize assessment of overall cardiovascular risk. European practice uses specific risk scales, while the 2025 American guidelines are moving toward the PREVENT model for assessing the 10-year risk of cardiovascular events. [57]

Target organ damage alters the severity of the grade. For example, left ventricular hypertrophy, urinary albumin, decreased renal function, hypertensive retinopathy, or a history of stroke place a patient at higher risk even with grade 1 blood pressure. [58]

That's why hypertension testing isn't limited to a tonometer. NICE recommends urine testing for albumin-to-creatinine ratio (ACR), blood testing for glycated hemoglobin, electrolytes, creatinine, glomerular filtration rate (GFR), lipids, fundus examination, and an electrocardiogram (ECG). [59]

Having a high risk doesn't mean a patient is "doomed." On the contrary, it's precisely in people at high risk that lowering blood pressure provides particularly significant benefits: it reduces the risk of stroke, heart attack, heart failure, and progression of chronic kidney disease. [60]

What is being assessed?	For what	Examples
Heart	Find overload and complications	Electrocardiogram, signs of hypertrophy
Kidneys	Find an early defeat	Creatinine, estimated glomerular filtration rate, urine albumin
Eyes	See vascular lesion	Hypertensive retinopathy
Metabolism	Assess the associated risk	Glucose, glycated hemoglobin, lipids
Vascular history	Understand existing events	Stroke, heart attack, peripheral arterial disease
Medicines and causes	Find secondary or drug-induced hypertension	Nonsteroidal anti-inflammatory drugs, hormones, stimulants

Source for table: NICE recommends that in hypertension, target organ damage and overall cardiovascular risk should be assessed rather than just blood pressure level. [61]

Treatment by degrees

For any degree of hypertension, lifestyle changes are essential. The World Health Organization indicates that a healthier diet, quitting smoking, increasing physical activity, reducing salt intake, losing weight, and limiting alcohol help lower blood pressure, although many people still need medication. [62]

For elevated blood pressure and stage 1 without high risk, a doctor can begin with non-drug measures and observation, but this should not lead to indefinite delays in treatment. The European Society of Cardiology 2024 recommends starting with 3 months of lifestyle changes for high blood pressure, followed by consideration of medications in people with a sufficiently high 10-year cardiovascular risk and a confirmed blood pressure of 130 over 80 mmHg or higher. [63]

For persistent stage 2 and 3 hypertension, drug therapy is usually required more quickly because the risk of complications is higher and lifestyle alone is often insufficient. Drug selection depends on age, comorbidities, renal function, potassium levels, pregnancy, tolerance, and existing medications. [64]

Major drug groups include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics; the World Health Organization lists these groups as common blood pressure lowering medications. The doctor makes the choice for a specific patient, as each group has its indications, contraindications, and monitoring requirements. [65]

Modern approaches increasingly use combinations of drugs, sometimes in a single pill, to improve adherence and achieve control more quickly. However, treatment should not be the same for everyone: approaches vary in pregnancy, chronic kidney disease, heart failure, coronary heart disease, atrial fibrillation, and old age. [66]

Pressure level	A common initial tactic	What you must take into account
High blood pressure	Lifestyle, risk assessment	High risk may speed up treatment
1st degree	Lifestyle plus medications according to risk	Diabetes, kidneys, heart, target organs
2nd degree	Often medication plus lifestyle	An organ damage assessment is needed.
3rd degree	Rapid medical assessment and treatment	Rule out an emergency
Isolated systolic hypertension	Treatment based on risk and tolerability	Risk of falls in the elderly
Resistant hypertension	Checking commitment, secondary causes, scheme	A specialist may be required

Source for table: European and American guidelines use pressure level, overall risk and organ damage to determine treatment intensity. [67]

Target blood pressure levels: what numbers to aim for

The treatment goal depends on the recommendations, age, tolerance, and comorbidities. The World Health Organization recommends that for most people, the goal is below 140/90 mmHg, and for those with cardiovascular disease, diabetes, chronic kidney disease, or high cardiovascular risk, the goal is often below 130/80 mmHg. [68]

The 2024 European Society of Cardiology guidelines emphasized a more robust approach: for adults receiving blood pressure medications, a target systolic pressure range of 120–129 mmHg is recommended, if tolerated. If this level is not tolerated, the target should be as low as reasonably achievable without harm. [69]

NICE uses more conservative clinical targets: for adults with hypertension under 80 years old – below 140/90 mmHg in the clinic; for people 80 years and older – below 150/90 mmHg, taking into account frailty and comorbidities. For home or outpatient monitoring, the thresholds are approximately 5 mmHg lower. [70]

The 2025 US guidelines reaffirm the overall goal of below 130/80 mmHg for adults, but emphasize individual characteristics and a new approach to assessing 10-year risk through the PREVENT model.[71]

The primary goal of goals is not to "drive blood pressure as low as possible at any cost," but to reduce the risk of complications without dizziness, falls, deterioration of kidney function, excessive weakness, and orthostatic hypotension. Goals are selected especially carefully in elderly, fragile patients, and those with severe symptoms upon standing. [72]

Recommendation	Typical goal	For whom it is especially important
World Health Organization	Below 140 to 90 for most	Basic global benchmark
World Health Organization at high risk	Below 130 to 80	Diabetes, chronic kidney disease, cardiovascular disease
European Society of Cardiology 2024	Systolic 120-129 as tolerated	Most adults in therapy
NICE under 80 years	Below 140 over 90 in the clinic	A practical British guide
NICE 80 years and older	Below 150 over 90 in the clinic	Taking into account fragility and falls
American recommendations for 2025	Below 130 to 80	Most adults, with individualization

Source for table: Pressure goals vary between systems, but all recommendations aim to reduce cardiovascular risk and avoid overtreatment in poorly tolerated patients. [73] [74]

Frequently asked questions

How does the degree of arterial hypertension differ from its stage? In the European tradition, "degree" most often refers to a pressure range: 1st, 2nd, or 3rd. In the American tradition, they speak of "stages": Stage 1 begins at 130 to 80 millimeters of mercury, and stage 2 begins at 140 to 90 millimeters of mercury. [75]

If my blood pressure is 145 over 92, what level is it? According to the European classification, this is stage 1 arterial hypertension if such values are repeatedly confirmed and measured correctly. But treatment depends not only on the number but also on age, risk factors, diabetes, kidney disease, heart disease, and target organ damage. [76]

If your blood pressure is 135 over 85, is that hypertension? According to the classic European and global thresholds, that's not yet hypertension, but in the new European 2024 system, it's "high blood pressure," while in the American system, it's stage 1 hypertension. In practice, this means assessing your risk and actively improving your lifestyle. [77] [78]

Why should home blood pressure be lower than at the doctor's? There's usually less stress and less of a "white coat" effect at home, so the diagnostic threshold for home or daytime outpatient blood pressure is lower: according to NICE, hypertension is confirmed by an average home or daytime outpatient blood pressure of 135/85 mmHg or higher, with an office blood pressure of 140/90 mmHg or higher. [79]

Can a diagnosis be made from a single measurement? Usually not. Blood pressure should be confirmed with repeated measurements, preferably ambulatory or home monitoring, unless there is an emergency. A single high reading may be due to stress, pain, caffeine, physical exertion, or measurement error. [80]

Which stage is the most dangerous? The higher the stage, the higher the risk, especially at stage 3. But a person with stage 1 and diabetes, chronic kidney disease, or a history of stroke may have a higher overall risk than a person with stage 2 without other factors. [81]

What is considered a hypertensive crisis? In everyday life, this term often refers to very high blood pressure, but medically, it's more significant when organ damage occurs: the brain, heart, kidneys, retina, or aorta. If blood pressure is around 180 over 120 millimeters of mercury or higher, accompanied by chest pain, shortness of breath, weakness, slurred speech, confusion, vomiting, or visual impairment, immediate medical attention is needed. [82]

Should I take medication at stage 1? Sometimes yes, sometimes no. If the risk is low and there is no organ damage, the doctor may start with lifestyle changes and observation; if the risk is high, with diabetes, kidney disease, cardiovascular disease, or organ damage, medication may be needed sooner. [83]

What tests are needed if hypertension is diagnosed? Urine albumin and blood counts, kidney function, electrolytes, glycated hemoglobin, lipids, fundus examination, and an electrocardiogram are typically assessed. This is necessary to detect target organ damage and determine risk. [84]

Should we rely solely on the upper pressure? No. Both the upper and lower pressures are important, but in older people, the upper pressure is often particularly significant due to arterial stiffness and isolated systolic hypertension. The International Classification of Diseases, 11th revision, even distinguishes between isolated systolic and isolated diastolic hypertension. [85]

What is considered a modern treatment goal? The goal depends on the guideline system and tolerability. The World Health Organization recommends below 140/90 for most people and below 130/80 for high-risk groups; the European Society of Cardiology 2024 recommends aiming for a systolic pressure of 120-129 for most adults on therapy, if tolerated. [86] [87]

What should you do if your blood pressure is high but you feel fine? Calmly repeat the measurement according to the instructions, record the values, and consult a doctor to confirm the diagnosis and assess your risk. If your blood pressure is very high or you experience chest pain, shortness of breath, neurological symptoms, visual impairment, confusion, nausea, or vomiting, seek medical attention immediately. [88]

Key points from experts

John William McEvoy, Professor, University of Galway School of Medicine, co-chair of the 2024 European Society of Cardiology guidelines working group. His group's key thesis is that the risk from blood pressure does not suddenly begin at one threshold, but increases continuously, which is why the 2024 European guidelines include a category of "high blood pressure" for people who have not yet reached classic hypertension but are already at increasing risk. [89]

Rhian M. Touyz, Professor, McGill University, Co-Chair of the European Society of Cardiology 2024 Guidelines Task Force. Key Message: For adults on therapy, the new European systolic pressure target range of 120-129 mmHg was chosen because intensive treatment data show a reduction in cardiovascular risk, but the target should take into account tolerability and the clinical situation. [90]

Giuseppe Mancia, Professor, lead author of the 2023 European Society of Hypertension guidelines. The practical message of this line of guidelines is that the traditional European classification of stages 1, 2 and 3 remains useful for describing pressure level, but treatment decisions should take into account overall cardiovascular risk, age and organ damage. [91]

Daniel W. Jones, MD, is one of the lead authors of the 2025 American Heart Association/American College of Cardiology guidelines. Key U.S. message: A target of less than 130/80 mmHg is confirmed for adults, and at 130-139 or 80-89 mmHg and low 10-year risk, medication is recommended if 3-6 months of lifestyle changes have not achieved the target. [92]

Experts from the National Institute for Health and Care Excellence. Their practical thesis: the diagnosis of hypertension should be confirmed not only by office measurements, but also by outpatient or home monitoring, and treatment should be accompanied by an assessment of target organ damage and regular follow-up. [93]

Experts from the World Health Organization. Their main public message: hypertension often causes no symptoms, but remains one of the leading causes of premature death, so regular blood pressure measurement, prevention, and treatment are critically important even when you feel well. [94]

Result

Arterial hypertension grades are a convenient way to describe pressure levels: Grade 1 corresponds to 140-159 or 90-99, Grade 2 is 160-179 or 100-109, and Grade 3 is 180 or 110 mmHg and above in the European classification. However, modern guidelines increasingly emphasize that the risk increases below these thresholds, especially in people with diabetes, chronic kidney disease, cardiovascular disease, and organ damage. [95] [96]

Proper diagnosis requires repeated measurements, measurements on both arms, home or 24-hour monitoring, and assessment of the heart, kidneys, fundus, metabolism, and overall cardiovascular risk. Without this, you could end up with a mistake in both directions: treating someone who only has the "white coat" effect, or missing hidden hypertension, which is higher at home and at night than in the office. [97] [98]

Treatment depends on the severity, risk, and tolerance: everyone needs lifestyle measures, many need medication, and severe blood pressure and symptoms of organ damage require urgent care. The main goal is not just to "knock down the numbers," but to reduce the risk of stroke, heart attack, heart failure, kidney damage, dementia, and premature death. [99]