Classification of systemic hypertension

classification of systemic hypertension

NICE categorise hypertension as (1):

Stage 1 hypertension

Clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg.

Stage 2 hypertension

Clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.

Stage 3 or severe hypertension

Clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.

The American college of Cardiology have redefined blood pressure into 4 levels*:

• normal
  • SBP <120 mmHg and DBP <80 mmHg
• elevated
  • SBP 120-129 mmHg and DBP <80 mmHg
• hypertension
  • stage 1 - SBP 130-139 mmHg or DBP 80-89 mmHg
  • stage 2 .- SBP >=140mmHg or DBP >=90mmHg (1)

individuals with SBP and DBP in 2 categories should be designated to the higher BP category (2).

Isolated Systolic Hypertension

Note:

• *meta analysis of observational studies have reported that elevated BP and hypertension are associated with increased risk of CVD, ESRD, subclinical atherosclerosis, and all-cause death. Hence early appreciation of elevated risk of cardiovascular disease (CVD) can aid in advising patients on lifestyle modification to lower BP, and to treat with antihypertensive medication to prevent CVD (2)

Reference:

• (1) NICE (August 2019). Clinical management of primary hypertension in adults
• (2) Whelton PK et al. 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: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e426-e483.
• (3) Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004- BHS IV. J Hum Hypertens 2004;18: 139-8