Grades and Stages of Hypertension
High blood pressure (hypertension) is one of the most common diseases of Western civilization. In the group of people over 45 years old, the hypertension rate is already nearly 50 percent - with an increasing trend.
High blood pressure refers to an increased pressure in the arteries. By definition, a blood pressure is considered normal if it is below 130/85. It is still considered high-normal at values below 139/89 mmHg. Although blood pressure can fluctuate significantly in different situations and certainly varies from person to person, a persistent blood pressure value above 140/90 mmHg is classified as high blood pressure.
Hypertension Grade 1 is referred to as mild hypertension with blood pressure values between 140 and 159 mmHg systolic and/or 90 to 99 mmHg diastolic. Although it is also called "mild hypertension," these values are already elevated and should not be taken lightly.
In consultation with the treating physician, a lifestyle change may be sufficient to bring the values back into the normal range; however, sometimes a medication therapy is essential.
Please note that according to the guidelines of the High Blood Pressure League, a blood pressure of >=135 and/or >=85 mmHg is considered high blood pressure in home measurements.
Hypertension Grade 2 already shows significantly high blood pressure values between 160-179 mmHg systolic and/or 100-109 mmHg diastolic. Medication therapy is necessary at this stage, in addition to the lifestyle changes mentioned above.
Hypertension Grade 3 is present when systolic is at or above 180 mmHg and/or diastolic is at 110 mmHg. Regardless of the stage of hypertension, there is a high risk of cardiovascular complications. To mitigate this, a medication therapy is urgently needed in addition to an adjusted lifestyle.
| Hypertension - Disease Stage |
Other Risk Factors, HMOD, CVD or CKD |
Blood Pressure Classification
(mmHg) | |||
|---|---|---|---|---|---|
| High Normal SBP 130-139 DBP 85-89 | Grade 1 SBP 140-159 DBP 90-99 | Grade 2 SBP 160-179 DBP 100-109 | Grade 3 SBP ≥ 180 or DBP ≥ 110 | ||
| Stage 1 | No additional risk factorsa | Low Risk | Low Risk | Moderate Risk | High Risk |
| 1 to 2 risk factors | Low Risk | Moderate Risk |
Moderate to High Risk |
High Risk | |
| ≥ 3 risk factors |
Low to Moderate Risk |
Moderate to High Risk |
High Risk | High Risk | |
| Stage 2 |
HMOD, CKD Stage 3 or Diabetes Mellitus |
Moderate to High Risk |
High Risk | High Risk | Very High Risk |
| Stage 3 | Manifest CVD or CKD Stage ≥ 4 | Very High Risk | Very High Risk | Very High Risk | Very High Risk |
Source: ESC/ESH Guidelines 2023
| < 50 years | 60-69 years | > 70 years |
Additional Risk Assessment in Stage 1 with SCORE2/SCOR2-OP |
|
|---|---|---|---|---|
| < 2.5% | < 5% | < 7.5% | ||
| 2.5% to < 7.5% | 5 to 10% | 7.5% to < 15% | ||
| ≥ 7.5% | ≥ 10% | ≥ 15% |
For more information and explanations of the abbreviations, please refer to the ESH Guidelines.
Additionally, hypertension, meaning a high blood pressure condition, is classified by WHO into three different stages:
- Stage I = without organ changes
- Stage II = with organ involvement - enlarged left side of the heart (left ventricular hypertrophy), mild blood pressure-related changes in the retina (retinopathy), mild blood pressure-related kidney damage (proteinuria)
asymptomatic, meaning the affected person does not yet notice the existing damage - Stage III = hypertensive organ damage - left heart failure (the heart no longer pumps with full force), damage to the central nervous system, more severe changes in the retina with bleeding and also kidney failure
in this stage, the damage is usually also noticeable to the affected person
Sources:
- https://www.gbe-bund.de/gbe/abrechnung.prc_abr_test_logon?p_uid=gast&p_aid=0&p_knoten=FID&p_sprache=D&p_suchstring=11737#Kap3.1
- https://www.hochdruckliga.de/fileadmin/downloads/mediziner/leitlinien/Pocket-Leitlinie_Hypertonie_2018.pdf
- https://journals.lww.com/jhypertension/Fulltext/9900/2023_ESH_Guidelines_for_the_management_of_arterial.271.aspx
By Sabine Croci.
This article is medically reviewed. Last updated by Horst Klier (12/2023).
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.
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