Harmonised Blood Pressure Normal Values from BloodPressureDB

BloodPressureDB uses harmonised normal values in the app and web version. For this, we compared international recommendations and thresholds and derived a single table for categorising blood pressure readings.

If youre looking for a quick overview, you can find it in our blood pressure table by age. On this page, we explain how the harmonised values were developed and how theyre used.

Introduction

To create a consistent and easy-to-understand basis for assessing blood pressure, we developed a globally harmonised table of normal values. Since blood pressure guidelines and target values sometimes differed and varied from country to country, it was often unclear when a blood pressure reading should be considered normal, elevated, or in need of treatment. Our internationally aligned table helps categorise blood pressure using uniform categories, providing a transparent and reliable guide for all users.

1. Summary

An overview of the global organisations on the topic of blood pressure

Hypertension is a global public health problem of considerable impact and a major risk factor for cardiovascular disease. Clear and consistent guidelines for the diagnosis and treatment of high blood pressure are essential to support healthcare professionals worldwide in their day-to-day clinical practice. This report provides a comparative analysis of the latest available guidance from leading medical societies across North America, Europe, South America, Africa, Asia, as well as Australia and New Zealand for the year 2025. It presents a harmonised overview of blood pressure classifications and highlights key differences in the recommended target values for specific patient groups. While there is general agreement on the basic blood pressure categories, there are clear variations in diagnostic threshold values and treatment targets, reflecting regional differences in population characteristics, healthcare systems, and evolving clinical evidence. One important trend observed in many guidelines is the endorsement of lower blood pressure targets, especially for people with diabetes, chronic kidney disease, and established cardiovascular disease. This development underlines the importance of intensive treatment in these high-risk groups. The variety of guidelines from different regions and professional societies points to a complex landscape that can be confusing for clinicians. This report aims to bring clarity and provide a basis for better understanding the global differences and shared approaches in hypertension management. The trend among many societies to pursue lower blood pressure targets, particularly for high-risk patients, is a key aspect that highlights the need for earlier and more intensive intervention.

2. Introduction

The global prevalence of high blood pressure is a significant threat to public health and contributes substantially to increased morbidity and mortality from cardiovascular events such as stroke, myocardial infarction, and kidney failure ¹. In light of this challenge, numerous medical societies have made considerable efforts to develop and share clinical guidelines for the prevention, detection, assessment, and treatment of high blood pressure. These guidelines, based on the latest scientific findings, serve as important resources for healthcare providers to standardise clinical practice and optimise patient outcomes. This report aims to provide a comprehensive and harmonised overview of the current landscape of global blood pressure normal values for adults in 2025. By examining the newest recommendations from major medical societies in North America, Europe, South America, Africa, Asia, as well as Australia and New Zealand, this analysis seeks to highlight both the areas of agreement and the differences in their approaches to defining and treating hypertension. The methodology for this report included a thorough review and synthesis of the latest hypertension guidelines published by important medical organisations within the geographical regions mentioned. It should be noted that the continuously evolving evidence base and improved understanding of regional healthcare needs lead to ongoing refinements of these guidelines. The inclusion of blood pressure measurement in children and adolescents is also considered an important aspect, particularly given the worldwide increase in obesity rates in this age group ¹. Ongoing updates to the guidelines underline the need for clinicians to stay up to date with the latest recommendations and to individualise treatment strategies based on a comprehensive assessment of each patients profile.

3. Harmonised Global Blood Pressure Classifications: A Detailed Analysis

The following table presents a harmonised classification of blood pressure categories in adults, compiled from the guidelines of various international medical societies ¹:

Category	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)
Low	<105	<65
Optimal	105–119	65–79
Normal	120–129	80–84
High-normal / Elevated	130–139	85–89
Hypertension Grade 1	140–159	90–99
Hypertension Grade 2	160-179	100-109
Hypertension Grade 3	>=180	>=110

Notes:
There are no normal values for low blood pressure. We do want to recognise low readings, but we dont label them as Optimal. Also note that, according to some guidelines, in home measurements a blood pressure of >=135 and/or >=85 mmHg is considered high blood pressure. For example, European guidelines from the European Society of Hypertension (ESH) recommend using this threshold as the cut-off for diagnosing hypertension based on home blood pressure measurements. The German Hypertension League (DHL) follows this recommendation. In Canada, toofor instance in the guidelines from the Canadian Hypertension Education Program (CHEP)a threshold of 135/85 mmHg is often used for home measurements.

Explanation:
This harmonised table acts as a simplified, general framework for understanding blood pressure categories. However, its important to emphasise that individual medical societies often use different classification systems with variations in terminology and specific numerical thresholds ¹. For example, the 2017 guideline from the American Heart Association (AHA) and the American College of Cardiology (ACC) in North America redefined hypertension using a lower threshold of ≥130/80 mmHg and introduced the category Elevated blood pressure for values between 120–129/<80 mmHg ¹. This change was based on growing understanding of the increased cardiovascular risk associated with blood pressure values that were previously considered prehypertension ¹. Similarly, the 2024 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) also introduced an Elevated blood pressure category, defined as 120–139/70–89 mmHg ¹, while keeping the hypertension threshold at ≥140/90 mmHg ¹. The 2019 guidelines from the Japanese Society of Hypertension (JSH) use terms such as High-normal blood pressure (120–129/<80 mmHg) and Elevated blood pressure (130–139/80–89 mmHg) and align their blood pressure thresholds with those in the US guidelines ¹⁸. The 2018 Korean hypertension guideline update from 2018 (Korean Society of Hypertension, KSH) in 2022 provides its own classification system ²³, while the 2024 Chinese guidelines (Chinese Hypertension League, CHL) continues to use 140/90 mmHg as the diagnostic threshold for hypertension ²⁴. The harmonised table is a useful starting reference, but a full understanding requires a detailed look at the specific guidelines issued by medical societies in different regions. The different definitions of hypertension from leading medical organisations show why clinicians need to be aware of regional differences and adjust their diagnostic and therapeutic approaches accordingly.

4. Regional and Society-Specific Blood Pressure Guidelines: A Comparative Overview

North America:

The 2017 guideline from the American Heart Association (AHA) and the American College of Cardiology (ACC) defined hypertension as a blood pressure of ≥130/80 mmHg, a significant change compared with the previous threshold of 140/90 mmHg ¹. This guideline also removed the category Prehypertension and replaced it with Elevated blood pressure for systolic values between 120–129 mmHg and diastolic values below 80 mmHg ¹. The recommendations emphasise a risk-based treatment approach and suggest a target blood pressure of <130/80 mmHg for adults with confirmed hypertension and existing cardiovascular disease or a 10-year risk of atherosclerotic cardiovascular disease (ASCVD) of 10 % or higher ¹. The AHA and ACC also promote the initiative Target: BP to improve blood pressure control rates ¹. The aggressive approach of AHA/ACC in defining and treating hypertension reflects a strong commitment to early intervention to reduce cardiovascular risk.
The American Diabetes Association (ADA) recommends in its Standards of Medical Care in Diabetes (2024) a blood pressure target of <130/80 mmHg for people with diabetes who have a higher cardiovascular risk ³¹. For many other adults with diabetes, a target value of <140/90 mmHg is still recommended ³¹. The ADAs differentiated targets highlight the importance of risk stratification when treating hypertension in people with diabetes.
The KDIGO guideline from 2021 for blood pressure management in chronic kidney disease (CKD) suggests a systolic blood pressure target of <120 mmHg for most adults with CKD, as long as it is tolerated ³⁵. This recommendation reflects a more intensive approach to blood pressure control in this high-risk population. The very low systolic target in the KDIGO guideline points to the high cardiovascular risk and the risk of progression of kidney disease in this patient group.
For hypertension in pregnancy, the 2019 guidelines of the American College of Obstetricians and Gynecologists (ACOG) define hypertension as a blood pressure of ≥140/90 mmHg ²⁷. ACOG recommends keeping blood pressure during pregnancy below 160/110 mmHg with antihypertensive treatment ²⁷. The higher treatment threshold used by ACOG for hypertension in pregnancy reflects the need to consider blood flow to the baby (fetal perfusion).

Europe:

The 2024 guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) define hypertension as a blood pressure of ≥140/90 mmHg ¹. For most adults who receive antihypertensive medication, these guidelines recommend a systolic target range of 120–129 mmHg, provided the treatment is well tolerated ¹. The ESC/ESH guidelines also provide age-specific blood pressure targets for older people ¹. The ESC/ESH approach is somewhat more conservative than AHA/ACC when it comes to defining hypertension, but it still supports lower target values.

South America:

The provided material suggests guidelines from the Sociedad Interamericana de Hipertensión (SIH), Sociedad Argentina de Hipertensión Arterial (SAHA) and Sociedade Brasileira de Cardiologia (SBC). However, specific details on their latest recommendations regarding blood pressure classifications and targets are not discussed in depth in the provided research ⁵⁸. The Inter-American Society of Cardiology (IASC) proposes using the blood pressure classification from the Latin American Society of Hypertension (LASH) ⁶². The 2017 LASH guidelines keep the classic definition of hypertension at ≥140/90 mmHg ⁶².

Africa:

In 2021, the Pan-African Society of Cardiology (PASCAR) published a commentary on the International Society of Hypertension (ISH) global hypertension practice guidelines from 2020 ¹. PASCARs approach emphasises resource-stratified recommendations for hypertension management across the continent ⁷¹. PASCAR proposes a classification that defines hypertension as ≥140/90 mmHg ⁷⁸.
The 2014 guidelines from the Southern African Hypertension Society (SAHS) define hypertension as persistently high blood pressure in the doctors office of ≥140/90 mmHg ⁷¹. SAHS recommends a universal target of <140/90 mmHg for antihypertensive treatment ⁷¹.

Asia:

The 2019 guidelines of the Japanese Society of Hypertension (JSH) define hypertension as ≥140/90 mmHg ¹⁸. The recommended target blood pressure in the clinic is <130/80 mmHg for adults under 75 years and <140/90 mmHg for people aged 75 years and above ¹⁸. The 2019 JSH guidelines largely match the US guidelines in terms of blood pressure threshold values.
The 2022 focused update of the 2018 Korean guidelines (Korean Society of Hypertension, KSH) generally recommends a target blood pressure of <140/90 mmHg, with a more intensive target of <130/80 mmHg for high-risk patients ²³. The KSH guidelines differentiate blood pressure targets based on the patients cardiovascular risk.
The 2024 guidelines from the Chinese Hypertension League (CHL) keep the diagnostic threshold for hypertension at 140/90 mmHg, but recommend a target blood pressure of <130/80 mmHg for most people if this can be tolerated ²⁴. The CHL guidelines are moving towards lower target blood pressure values, similar to other regions.
Experts at the 76th annual meeting of the Cardiological Society of India (CSI) presented new guidelines for hypertension management in 2024, emphasising an ideal blood pressure below 120/80 mmHg ⁹⁹. For people over 80 years, slightly higher values may be acceptable ⁹⁹. The CSI guidelines appear to aim for a very strict ideal blood pressure.

Australia and New Zealand:

The 2016 guidelines of the National Heart Foundation of Australia (NHF) define hypertension as a blood pressure in the doctors office of 140/90 mmHg or higher ⁶. They recommend a target of <140/90 mmHg, while lower targets (<120 mmHg systolic) for high-risk groups are considered appropriate if well tolerated ⁶. The National Hypertension Taskforce aims to increase blood pressure control rates to 70 % by 2030 ¹⁰².
The 2018 consensus statement by the Cardiac Society of Australia and New Zealand (CSANZ) and the New Zealand Ministry of Health recommends individualising blood pressure targets based on the risk of cardiovascular disease ¹. For people with high CVD risk, the target is <130/80 mmHg, while for lower risk it is <140/90 mmHg ¹. Guidelines in Australia and New Zealand increasingly emphasise the importance of cardiovascular risk assessment to guide blood pressure targets.
The 2023 guidelines of the Society of Obstetric Medicine Australia and New Zealand (SOMANZ) define hypertension in pregnancy as ≥140/90 mmHg and recommend a target blood pressure value of <=135/85 mmHg ⁷¹.

5. Blood Pressure Management for Special Patient Groups: A Global Perspective

Patients with Diabetes Mellitus: In general, guidelines recommend a target blood pressure of <140/90 mmHg for most patients with diabetes ³¹. Many professional societies, including the ADA, JSH, KSH, and CSI, however, propose a stricter target of <130/80 mmHg for patients with high cardiovascular risk ³¹. Preferred antihypertensive medicines are often ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics ¹.
Patients with chronic kidney disease (CKD): The KDIGO guideline recommends a systolic target of <120 mmHg ³⁵, while the ESC/ESH suggest <140/90 mmHg (with <130/80 mmHg if tolerated) ³⁵. Other guidelines, such as JSH, KSH, CHL, NHF, and CSANZ/NZ, also generally recommend target values around <130/80 mmHg ³⁵. ACE inhibitors and ARBs are often preferred ¹.
Older adults: Blood pressure targets for older adults vary significantly ¹. ESC/ESH recommends <140/80 mmHg for people aged 65 to 79 and 140–150 mmHg systolic for those aged 80 and over ¹. AHA/ACC suggests <130/80 mmHg and takes frailty into account ¹. JSH targets <140/90 mmHg for those aged 75 and above ⁵⁸. CSI recommends <135/80 mmHg for people over 80 ⁴. NHF aims for <120 mmHg systolic for those aged 75 and above if tolerated ¹⁴².
Pregnant people: ESC/ESH and CSI recommend a target of <140/90 mmHg ¹. SOMANZ suggests <=135/85 mmHg ⁷¹. ACOG recommends <160/110 mmHg ¹¹.
Children and adolescents: AHA defines hypertension as ≥130/80 mmHg for children and adolescents aged 13 and above and for those aged 13 and above and above the 95th percentile for younger children ¹⁰. ESC uses ≥140/90 mmHg for those aged 16 and above and for those aged 16 and above the 95th percentile for younger children ¹⁴. KSH uses ≥140/90 mmHg for those aged 17 and above and above the 95th percentile for younger children ¹⁵⁴. NHF uses ≥120/80 mmHg for those aged 13 and above and above the 95th percentile for younger children ¹⁷.
Patients with cardiovascular disease (CAD, stroke): In general, a target value of <130/80 mmHg is recommended for patients with stroke ¹, coronary heart disease ¹ and heart failure ⁴.

6. Key Differences, Similarities, and New Trends in Global Hypertension Guidelines

One major difference between global guidelines is the threshold value used to diagnose hypertension. AHA/ACC supports a lower threshold of 130/80 mmHg, compared with ESC/ESH, JSH, and CHL, which keep the traditional value of 140/90 mmHg ¹. Despite this difference, all guidelines strongly agree on the fundamental role of lifestyle changes including dietary changes, regular physical activity, weight management, and quitting smoking as a cornerstone of hypertension management ¹. A notable trend observed across different regions is the increasing adoption of lower blood pressure targets, especially for people identified as high-risk for cardiovascular events, such as patients with diabetes, chronic kidney disease, or a history of stroke or heart attack ¹. This shift is largely due to increasing evidence from clinical trials showing the benefits of more intensive blood pressure control in these populations ¹. In addition, there is growing emphasis on the importance of measuring blood pressure outside the doctors office, including both home blood pressure measurements and ambulatory blood pressure monitoring, for more accurate diagnosis and effective long-term management of hypertension ¹. Finally, hypertension in specific populations such as children, adolescents, and pregnant people is receiving increasing attention, which is leading to the development of more specific guidelines for these groups ¹. A new trend is the growing recommendation of single-pill combination therapy to improve medication adherence ¹. The inclusion of newer technologiessuch as validated portable devices for screening and monitoringalso appears to be a direction for more continuous, patient-centred blood pressure management in the future ¹. The different recommendations on blood pressure targets for older adults and patients with CKD highlight areas where further research and agreement are still needed ¹.

7. Recommendations for Clinical Practice and Future Research

Healthcare professionals should be familiar with the specific guidelines that are relevant to their region and patient population ¹. A personalised approach to blood pressure management is recommended, taking into account individual risk factors, comorbidities, and patient preferences ¹. Accurate blood pressure measurement techniques and the role of blood pressure measurement outside the doctors office should be emphasised ¹. Ongoing patient education and support to encourage lifestyle changes and medication adherence are essential ¹. Future research directions include studies to further clarify optimal blood pressure targets in specific populations, such as very old, frail individuals and those with complex comorbidities ¹. Further research is needed to evaluate the long-term impact of introducing lower diagnostic thresholds for hypertension ¹. Studies assessing the effectiveness and cost-effectiveness of newer technologies for blood pressure measurement and treatment are required ¹. It would also be desirable to further investigate strategies to improve global harmonisation of hypertension guidelines ¹. Additional research is needed to examine how blood pressure management with lower target values affects pregnancy outcomes ¹. Studies on optimal blood pressure targets in children and adolescents that consider long-term cardiovascular outcomes are also necessary ¹.

8. Conclusion

The global blood pressure guidelines for 2025 present a complex picture that reflects both areas of agreement and significant differences ¹. Adhering to evidence-based clinical guidelines is crucial for the effective management of hypertension and for preventing the cardiovascular complications associated with it ¹. Healthcare professionals must recognise both the similarities andmore importantlythe nuances and differences between recommendations from different international medical societies ¹. Applying these global guidelines requires careful consideration of individual patient characteristics, including their age, existing comorbidities, overall cardiovascular risk profile, and the specific context of their regional healthcare setting ¹. Since the research field of hypertension continues to develop, the guidelines are expected to undergo further revisions and updates ¹. Therefore, ongoing professional development and staying engaged with the latest findings are essential to provide optimal, patient-centred care when managing this common and significant health condition ¹.

9. Appendix

Table 2: Comparison of blood pressure classifications and treatment targets of major global guidelines

Guideline	Definition of hypertension (general adult population)	Target blood pressure (general adult population)	Target blood pressure (people with diabetes)	Target blood pressure (CKD patients)	Target blood pressure (older adults)	Target blood pressure (pregnant people)	Definition of hypertension (adolescents ≥13 years)	Target blood pressure (patients with CVD)
AHA/ACC (2017)	≥130/80 mmHg	<130/80 mmHg	<130/80 mmHg	<130/80 mmHg	<130/80 mmHg	≥140/90 mmHg, Treatment at ≥160/110 mmHg	≥130/80 mmHg	<130/80 mmHg
ESC/ESH (2024)	≥140/90 mmHg	120–129 mmHg systolic	<130/80 mmHg	<140/90 mmHg (<130/80 if tolerated)	<140/80 mmHg (65–79), 140–150 systolic (≥80)	<140/90 mmHg	≥140/90 mmHg (≥16 years)	<130/80 mmHg
JSH (2019)	≥140/90 mmHg	<130/80 mmHg (<75 years), <140/90 mmHg (≥75 years)	<130/80 mmHg	<130/80 mmHg (proteinuria +), <140/90 mmHg (proteinuria –)	<140/90 mmHg (≥75 years), <130/80 mmHg (<75 years if tolerated)	≥140/90 mmHg	≥130/80 mmHg	<130/80 mmHg
KSH (2022)	≥140/90 mmHg	<140/90 mmHg (low-to-moderate risk), <130/80 mmHg (high risk)	<130/80 mmHg (high risk), <140/90 mmHg (low-to-moderate risk)	<130/80 mmHg (with albuminuria), <140/90 mmHg (without albuminuria)	<140/90 mmHg (≥65 years)	≥140/90 mmHg, Treatment at ≥160/90 mmHg	≥130/80 mmHg	<130/80 mmHg
CHL (2024)	≥140/90 mmHg	<130/80 mmHg (if tolerated)	<130/80 mmHg (if tolerated)	<130/80 mmHg (if tolerated)	<150 mmHg systolic (65–79), <150 mmHg systolic (≥80)	≥140/90 mmHg	≥140/90 mmHg	<130/80 mmHg (if tolerated)
PASCAR (2021 Commentary on ISH 2020)	≥140/90 mmHg	<140/90 mmHg	<130/80 mmHg	<130/80 mmHg	<150/90 mmHg systolic (≥80 years)	≥140/90 mmHg	≥140/90 mmHg	<130/80 mmHg
SAHS (2014)	≥140/90 mmHg	<140/90 mmHg	<140/90 mmHg	<140/90 mmHg	<140/90 mmHg	140–150 mmHg systolic (≥80 years if systolic >160)	≥140/90 mmHg	N/A	<140/90 mmHg
NHF (2016)	≥140/90 mmHg	<140/90 mmHg (<120 systolic if high risk)	<130/80 mmHg	<120 mmHg systolic	<120 mmHg systolic (≥75 years if tolerated)	≥140/90 mmHg	≥140/90 mmHg	<120 mmHg systolic
CSANZ/NZ (2018)	≥140/90 mmHg	<140/90 mmHg (lower risk), <130/80 mmHg (high risk)	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)	<140/90 mmHg (lower risk), Targets individualised for frail/dementia patients	≥140/90 mmHg, Treatment at ≥160/100 mmHg, Target <=135/85 mmHg	≥130/80 mmHg	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)

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