Table 4: Comparison of Blood Pressure Targets and time to initiate pharmacologic treatment.

Guidelines

BP targets

BP classification

BP thresholds (mmHg)

When to initiate Pharmacologic treatment

SBP

DBP

 

JNC 7, 2003

< 140/90 mmHg

Normal

< 120

< 80

≥ 140 mmHg for 30-59 years

< 130/80 mmHg for those with diabetes or Chronic Kidney disease

Prehypertension

120-139

80-89

 

Stage I hypertension

140-159

90-99

 

Stage 2 hypertension

≥ 160

≥ 100

 

JNC 8, 2014

< 150/90 mmHg for patients ≥ 60 years

JNC 8, did not discuss hypertension diagnostic thresholds

≥140 mmHg for 30-59 years

≥ 150/90 mmHg for 60yrs and older

< 140/90 mmHg for patients < 60, diabetes and CKD

Based on expert opinion for 18-29 years

ACC/AHA, 2018

< 130/80 mm Hg

Normal

< 120

< 80

≥ 140/90 mmHg for low risk (10-yrs CVD risk < 10%)

Elevated

120-129

< 80

Stage 1 hypertension

130-139

80-89

≥ 130/ 80 mmHg for all others

Stage 2 hypertension

≥ 140

≥ 90

 

National NCD guidelines of Ethiopia, 2016

< 140/90 mmHg

Normal

< 120

< 80

 

< 150/90 mmHg for patients >75 years

Pre-hypertension

120-139

 80-89

≥160/100 mmHg low risk

Stage 1 hypertension

140-159

90-99

≥ 140/90 mmHg for high risk

Stage 2 hypertension

≥ 160

≥ 100

≥130/80 mmHg for very high risk patients

Severe hypertension

≥ 180

≥ 110

HEARTs package for CVDs, 2018

< 140/90 mmHg

Normal

< 120

< 80

 

< 130/80 mmHg for patients with High risk of CVDs and diabetic patients

Prehypertension

120-139

80-89

≥ 140/90 mmHg

Stage I hypertension

140-159

90-99

≥ 130/80 mmHg for high risk (CHD, Cerebrovascular disease)

Stage 2 hypertension

≥ 160

≥ 100

 

Hypertension Canada, 2017

< 120/ 80 mmHg, High risk

Normal

< 120

< 80

≥ 120/ 80 mmHg for High risk

< 130/80 mmHg, diabetics

Elevated

120-129

< 80

≥ 130/80 mmHg for diabetics

< 140/90 mmHg for others

Stage 1 hypertension

130-139

80-89

≥140/90 mmHg, Moderate risk

Stage 2 hypertension

≥ 140

≥ 90

≥160/100 mmHg, low risk

Hypertension guideline Australia, 2016

< 120/ 80 mmHg, High risk

Optimal

< 120

< 80

 

Normal

120-129

80-84

≥ 120/ 80 mmHg, High risk

High normal

130-139

85-89

≥140/90 mmHg, Moderate risk

< 140/90 mmHg for others

Grade 1 (Mild)

140-159

90-99

≥160/100 mmHg, low risk

Grade 2 (Moderate)

160-179

100-109

 

Grade 3 (Severe)

≥ 180

≥ 110

 

Isolated systolic

> 140

< 90

 

ESC/ESHGuidelines, 2018

< 140/90 mmHg in all patients, if tolerable

< 130/80 mmHg

Optimal

< 120

<80

130-139/80-89 mmHg, Consider in very high risk

Normal

120–129

80-84

High normal

130–139

85-89

140-159/90-99mmHg, immediately start in very high risk and 3-6 months lifestyle intervention for low risk

120-129/< 80 mmHg in < 65 years

Grade 1 Hypertension

140–159

90-99

Grade 2 Hypertension

160–179

100-109

130-139/< 80 mmHg in ≥ 65 years

Grade 3 Hypertension

≥ 180

≥ 110

≥ 160/100, immediately start and aim to control BP in 3 months

Isolated Systolic Hypertension

≥ 140

< 90

BP indicates blood pressure (based on an average of ≥ 2 careful readings obtained on ≥ 2 occasions). Patients with SBP and DBP in two different categories should be classified in the higher category. BP: Blood Pressure; TIA: Transient Ischemic Attack; Low risk: no CVD or CV risk factors or absolute CVD 5 year risk < 5% ; Moderate risk: absolute 5 year CVD risk, 10-15%; High Risk 10-year CVD risk 20-30% and Very high risk 10-year CVD risk > 30%.