How is high blood pressure staged

Based on the current level of medical development and examination methods, can find the exact cause of blood pressure increase, called secondary hypertension; On the other hand, if the exact cause of increased blood pressure cannot be found, it is called Primary hypertension. The majority of people with hypertension are Primary hypertension,the classification of hypertension is actually the classification of primary hypertension.

1. Hypertension is divided into three stages.

Stage I Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure fluctuating between 12.0 and 13.3 kPa (90-100 mmHg) most of the time, and is able to return to normal after rest, with no clinical manifestations of heart, brain or kidney complications.

Stage II Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure exceeding 13.3kPa (100mmHg) or more, unable to drop to normal after rest, and with one of the following.

• (i) X-ray, electrocardiogram or echocardiogram examination with signs of left ventricular hypertrophy. 
• (ii) Funduscopic examination, which shows widespread or localized narrowing of the skull base arteries.
• (iii) Proteinuria and/or mildly elevated plasma creatinine concentration.

Stage III Blood pressure reaches the level of confirmed hypertension, with diastolic blood pressure exceeding 14.7-16.0 kPa (110-120 mmHg), and one of the following.

• (1) cerebrovascular accident or hypertensive encephalopathy.
• (2) left heart failure.
• (3) renal failure.
• (4) Bleeding or exudation from the fundus of the eye with or without optic papilloedema.

2. High blood pressure classification :

Grade 1 hypertension (mild): systolic blood pressure 140-159mmHg or diastolic blood pressure 90-99mmHg

Grade 2 hypertension (moderate): systolic blood pressure 160 to 179 mmHg or diastolic blood pressure 100 to 109 mmHg

Grade 3 hypertension (severe): systolic blood pressure ≥180mmHg or diastolic blood pressure ≥110mmHg

3. ACC/AHA Hypertension Guidelines 2017

The Seventh Report of the U.S. Joint National Commission on the Prevention, Detection, Evaluation, and Treatment of Hypertension, divides blood pressure levels into four categories.

• Normotensive: (≤120/80mmHg)
• Pre-hypertension :( 120-139/80-89mmHg)
• Stage 1 hypertension :( 140-159/90-99mmHg)
• Stage 2 hypertension :( ≥160/100mmHg)

On November 13, 2017, at the Annual Meeting of the American Heart Association(AHA), the 2017 American College Cardiology(ACC/AHA) guidelines for Hypertension in the United States were released. The guidelines abolish the original "pre-hypertensive" blood pressure classification and classify blood pressure into four grades: normal blood pressure elevated blood pressure, grade 1 hypertension, and Grade 2 hypertension (I/B).

In the new strategy for initiating antihypertensive therapy for hypertension, ACC recommends that antihypertensive therapy should be initiated when blood pressure is ≥130/80 mmHg (1 mmHg=0.133 kPa) in patients with pre-existing cardiovascular disease or 10-year risk of atherogenic cardiovascular disease (ASCVD) is ≥10%; No previous cardiovascular disease and 10-year risk of ASCVD. Antihypertensive therapy was initiated in <10% of patients with blood pressure ≥140/90 mmHg. ACC suggests that these changes strengthen blood pressure control in people at high risk of cardiovascular disease by emphasizing that antihypertensive treatment is based on a patient's cardiovascular risk assessment for patients with blood pressure ≥130/80 mmHg.

4. European Guidelines for the Management of hypertension 2018

The European Guidelines for the Prevention and Control of Hypertension 2003 present the criteria for the diagnosis of hypertension with different blood pressure measurements:

• clinic blood pressure of 140/90 mmHg.
• 24-hour ambulatory blood pressure of 125/80 mmHg.
• 135/85 mmHg for home self-measured blood pressure.
• The goal of antihypertensive treatment is to lower blood pressure to below 140/90 mmHg; diabetic patients should be lowered to below 130/80 mmHg.

At the 28th Annual European Conference on Hypertension and Cardiovascular Protection on 9 June 2018, Published the 2018 European Guidelines for the Management of Hypertension by the European Society of Cardiology(ESC) and The European Society of Hypertension(ESH), guidelines used the 2013 version of the guidelines for the classification of clinic blood pressure and the definition of hypertension grade.

The new European guidelines include blood pressure ≥140/90 mmHg as the diagnostic criteria for hypertension. Although the definitions are based on in-office blood pressure measurements, the new guidelines increase the role and role of 24 h ambulate blood pressure measurements (ABPM) and home blood pressure measurements (HBPM) in the diagnosis of hypertension.Although the new guidelines do not modify the diagnostic criteria for hypertension, they are more aggressive in the treatment of hypertension.

The 2018 guidelines have significantly modified the above recommendations :

• (1) life intervention is recommended for high normal values , and antihypertensive drug therapy is considered when cardiovascular disease, especially coronary heart disease, is present at the same time ; 
• (2)age between 65 years old and 80 years old patients with grade 1 hypertension, if they can tolerate it, antihypertensive drugs should be used in addition to recommended lifestyle interventions ; 
• (3) Patients at high risk of grade 1 hypertension or with target organ damage caused by hypertension (HMOD) should immediately start antihypertensive therapy along with lifestyle intervention . In addition, antihypertensive therapy is recommended for patients with low and medium risk grade 1 hypertension without HMOD, whose blood pressure still fails to meet the standard after 3 to 6 months of a lifestyle intervention .

In the new European Hypertension Guidelines 2018, the timing of the initiation of antihypertensive therapy should not only consider blood pressure level but also consider the combination of cardiovascular disease, chronic kidney disease, diabetes, and other cardiovascular high-risk conditions. In addition, for age > 65-year-old patient with grade 1 hypertension was treated more aggressively than before.

American College Cardiology

European Society of Cardiology

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