Harmonized Global Normal Values for Blood Pressure

Introduction

To provide a clear and easy-to-understand basis for assessing blood pressure, we have developed a globally harmonized reference table. Because guidelines and target values for blood pressure sometimes differed and varied from country to country, there was often confusion about when a blood pressure reading should be considered normal, elevated, or in need of treatment. Our internationally aligned table helps classify blood pressure using consistent categories and gives a transparent and reliable orientation for all users.

1. Summary

Hypertension is a major global health problem and a key risk factor for cardiovascular disease. Clear, consistent guidance for diagnosing and treating high blood pressure is essential to support healthcare professionals worldwide in clinical practice. This report provides a comparative analysis of the latest available guidelines from leading medical societies in North America, Europe, South America, Africa, Asia, and Australia/New Zealand for 2025. A harmonized overview of blood pressure classifications is presented, and the main differences in recommended targets for specific patient groups are highlighted. While there is general agreement on the basic categories of blood pressure, there are notable variations in diagnostic thresholds and treatment targets that reflect regional differences in population characteristics, healthcare systems, and evolving clinical evidence. One important trend seen in many guidelines is support for lower blood pressure targets, particularly for people with diabetes, chronic kidney disease, and established cardiovascular disease. This trend underscores the importance of more intensive treatment in these high-risk groups. The variety of guidelines from different regions and societies points to a complex landscape that can be confusing for clinicians. This report aims to clarify the situation and provide a basis for better understanding global differences and commonalities in hypertension management. The tendency of many societies to aim for lower blood pressure targets, especially in high-risk patients, is a key point that highlights the need for early and intensive intervention.

2. Background

The global prevalence of high blood pressure poses a major public health threat and contributes substantially to increased morbidity and mortality from cardiovascular events such as stroke, heart attack, and kidney failure ¹. In response, many medical societies have made significant efforts to develop and disseminate clinical guidelines for the prevention, detection, evaluation, and treatment of high blood pressure. These guidelines, based on the latest scientific evidence, serve as important resources for healthcare providers to standardize clinical practice and improve patient outcomes. This report aims to give a comprehensive, harmonized overview of the current landscape of global blood pressure reference values for adults in 2025. By reviewing the most recent recommendations from major medical societies in North America, Europe, South America, Africa, Asia, and Australia/New Zealand, this analysis seeks to highlight both consensus and 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 key medical organizations in the specified regions. It should be noted that the continuously evolving evidence base and a growing understanding of regional health needs lead to ongoing refinement of these guidelines. Including blood pressure measurement in children and adolescents is also considered an important aspect, especially given rising obesity rates in this age group worldwide ¹. Continuous updates to guidelines emphasize the need for clinicians to stay informed about the latest recommendations and to tailor treatment strategies based on a comprehensive assessment of each patients individual profile.

3. Harmonized Global Blood Pressure Classifications: A Detailed Analysis

The table below presents a harmonized 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 stage 1	140–159	90–99
Hypertension stage 2	160-179	100-109
Hypertension stage 3	>=180	>=110

Notes:
There are no standardized reference values for low blood pressure. However, we do not want to label low readings as "optimal." Please also note that some guidelines consider a home blood pressure of >=135 and/or >=85 mmHg to indicate hypertension. For example, the European Society of Hypertension (ESH) recommends this threshold for diagnosing hypertension using home blood pressure monitoring. The German Hypertension League (DHL) follows this recommendation. In Canada, guidelines such as those from the Canadian Hypertension Education Program (CHEP) also commonly use a threshold of 135/85 mmHg for home measurements.

Explanation:
This harmonized table serves as a simplified, general framework for understanding blood pressure categories. It is important to stress that individual medical societies often use different classification systems with variations in terminology and specific numeric 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 at 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 evidence of increased cardiovascular risk associated with blood pressure levels that were previously considered prehypertensive 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 diagnostic threshold at ≥140/90 mmHg ¹. The 2019 guidelines of the Japanese Society of Hypertension (JSH) use terms like "High-normal blood pressure" (120–129/<80 mmHg) and "Elevated blood pressure" (130–139/80–89 mmHg) and align their thresholds with the U.S. guidelines ¹⁸. The focused 2022 update of the Korean guidelines (Korean Society of Hypertension, KSH) provides its own classification system ²³, while the 2024 Chinese guidelines (Chinese Hypertension League, CHL) continue to use 140/90 mmHg as the diagnostic threshold for hypertension ²⁴. The harmonized table is a useful first reference, but a full understanding requires a detailed review of the specific guidelines published by medical societies in different regions. The differing definitions of hypertension among leading medical societies highlight the need for clinicians to be aware of regional differences and to adapt their diagnostic and treatment 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 from 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 under 80 mmHg ¹. The recommendations emphasize a risk-based treatment approach and suggest a target blood pressure of <130/80 mmHg for adults with confirmed hypertension who have established cardiovascular disease or a 10-year risk for atherosclerotic cardiovascular disease (ASCVD) of 10% or higher ¹. The AHA and ACC also promote the "Target: BP" initiative to improve blood pressure control rates ¹. The AHA/ACC's more aggressive approach to 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 higher cardiovascular risk ³¹. For many other adults with diabetes, a target of <140/90 mmHg is still recommended ³¹. The ADA's differentiated targets underline the importance of risk stratification when treating hypertension in people with diabetes.
• The Kidney Disease: Improving Global Outcomes (KDIGO) guideline from 2021 for blood pressure management in chronic kidney disease (CKD) recommends a systolic blood pressure target of <120 mmHg for most adults with CKD, if tolerated ³⁵. This recommendation reflects a more intensive approach to blood pressure control in this high-risk population. KDIGO's very low systolic target points to the high cardiovascular risk and the risk of kidney disease progression in these patients.
• For hypertension in pregnancy, the 2019 guidelines from 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. ACOG's higher treatment threshold in pregnancy reflects the need to consider fetal perfusion.
• Europe:
• The 2024 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) define hypertension as a blood pressure of ≥140/90 mmHg ¹. These guidelines recommend, for most adults receiving antihypertensive medication, a systolic target range of 120–129 mmHg if 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 the AHA/ACC regarding the definition of hypertension, but it still supports lower treatment targets.
• South America:
• The material provided points to guidelines from the Sociedad Interamericana de Hipertensión (SIH), Sociedad Argentina de Hipertensión Arterial (SAHA), and the Sociedade Brasileira de Cardiologia (SBC). Specific details on their latest recommendations for blood pressure classifications and targets were not extensively covered in the provided research ⁵⁸. The Inter-American Society of Cardiology (IASC) recommends using the blood pressure classification of the Latin American Society of Hypertension (LASH) ⁶². LASH's 2017 guidelines retain the classic definition of hypertension at ≥140/90 mmHg ⁶².
• Africa:
• The Pan-African Society of Cardiology (PASCAR) published a commentary in 2021 on the 2020 global hypertension practice guidelines of the International Society of Hypertension (ISH) ¹. The PASCAR approach emphasizes resource-stratified recommendations for hypertension management across the continent ⁷¹. PASCAR> proposes a classification that defines high blood pressure as ≥140/90 mmHg ⁷⁸.
• The guidelines of the Southern African Hypertension Society (SAHS) from 2014 define hypertension as a persistently high blood pressure in the doctor's office of ≥140/90 mmHg ⁷¹.  SAHS recommends a universal treatment target of <140/90 mmHg for blood pressure management ⁷¹.
• Asia:
• The Japanese Society of Hypertension (JSH) guidelines from 2019 define high blood pressure as ≥140/90 mmHg ¹⁸.  The recommended target blood pressure measured in the doctor's office is <130/80 mmHg for adults under 75 years and <140/90 mmHg for people aged 75 years and older ¹⁸.  The JSH 2019 guidelines largely agree with the US guidelines on blood pressure thresholds.
• The focused update of the Korean guidelines from 2018 (Korean Society of Hypertension, KSH), revised in 2022, 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 tailor blood pressure goals based on the patient's cardiovascular risk.
• The Chinese Hypertension League (CHL) guidelines from 2024 keep the diagnostic threshold for hypertension at 140/90 mmHg,  but recommend a target blood pressure of <130/80 mmHg for most people if tolerated ²⁴.  The CHL guidelines are moving toward lower target blood pressures, similar to trends in other regions.
• Experts at the 76th Annual Meeting of the Cardiological Society of India (CSI) presented new hypertension management guidelines in 2024 that emphasize an ideal blood pressure below 120/80 mmHg ⁹⁹.  Slightly higher values may be acceptable for people over 80 years ⁹⁹.  The CSI guidelines appear to aim for a very strict ideal blood pressure.
• Australia and New Zealand:
• The National Heart Foundation of Australia (NHF) guidelines from 2016 define hypertension as a blood pressure in the doctor's office of 140/90 mmHg or more ⁶.  They recommend a target of <140/90 mmHg, with lower goals (<120 mmHg systolic) for high-risk groups if well tolerated ⁶.  The National Hypertension Taskforce aims to increase blood pressure control rates to 70 % by 2030 ¹⁰².
• The 2018 consensus statement from the Cardiac Society of Australia and New Zealand (CSANZ) and the New Zealand Ministry of Health recommends individualizing blood pressure targets based on cardiovascular risk ¹.  For people at 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 stress the importance of cardiovascular risk assessment to guide blood pressure goals.
• The 2023 guidelines from the Society of Obstetric Medicine Australia and New Zealand (SOMANZ) define hypertension in pregnancy as ≥140/90 mmHg and recommend a blood pressure target of ≤135/85 mmHg ⁷¹.

5. Blood pressure management for special patient groups: a global perspective

• Patients with diabetes:  Guidelines generally recommend a target blood pressure of <140/90 mmHg for most people with diabetes ³¹.  Many professional societies, including the ADA, JSH, KSH and CSI, however, suggest a stricter target of <130/80 mmHg for patients with high cardiovascular risk ³¹.  Preferred antihypertensive drugs often include ACE inhibitors, ARBs, calcium channel blockers and thiazide diuretics ¹.
• Patients with chronic kidney disease (CKD):  The KDIGO guideline recommends a systolic target blood pressure of <120 mmHg ³⁵, while the ESC/ESH suggests <140/90 mmHg (with <130/80 mmHg if tolerated) ³⁵.  Other guidelines, such as JSH, KSH, CHL, NHF and CSANZ/NZ, generally recommend targets around <130/80 mmHg ³⁵.  ACE inhibitors and ARBs are often preferred ¹.
• Older adults:  Blood pressure targets for older adults vary considerably ¹.  ESC/ESH recommends <140/80 mmHg for 65- to 79-year-olds and 140–150 mmHg systolic for those ≥80 years ¹.  AHA/ACC suggests <130/80 mmHg, taking frailty into account ¹.  JSH targets <140/90 mmHg for those ≥75 years ⁵⁸.  CSI recommends <135/80 mmHg for people over 80 years ⁴.  NHF aims for <120 mmHg systolic for those ≥75 years, 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 those aged ≥13 years and as ≥95. percentile for younger children ¹⁰.  ESC uses ≥140/90 mmHg for those aged ≥16 years and ≥95. percentile for younger children ¹⁴.  KSH uses ≥140/90 mmHg for those aged ≥17 years and ≥95. percentile for younger children ¹⁵⁴.  NHF uses ≥120/80 mmHg for those aged ≥13 years and ≥95. percentile for younger children ¹⁷.
• Patients with cardiovascular disease (coronary heart disease, stroke):  In general, a target of <130/80 mmHg is recommended for patients with stroke ¹, coronary artery disease ¹  and heart failure ⁴.

6. Key differences, similarities and new trends in global hypertension guidelines

A major difference between global guidelines is the diagnostic threshold for hypertension: the AHA/ACC favors a lower threshold of 130/80 mmHg, compared with the ESC/ESH, JSH and CHL, which keep the traditional 140/90 mmHg ¹. Despite this difference, all guidelines strongly agree on the core role of lifestyle changessuch as dietary changes, regular physical activity, weight management and quitting smokingas the foundation of blood pressure management ¹. A notable trend seen in various regions is the increasing adoption of lower blood pressure targets, especially for people identified as high risk for cardiovascular events, such as those with diabetes, chronic kidney disease or a history of stroke or heart attack ¹. This shift is largely driven by growing evidence from clinical trials showing benefits of more intensive blood pressure control in these groups ¹. In addition, there is increasing emphasis on measuring blood pressure outside the doctor's office, including both home and ambulatory blood pressure monitoring, for more accurate diagnosis and effective long-term management of hypertension ¹. Hypertension in specific populations such as children, adolescents and pregnant people is also receiving more attention, leading to more tailored guidelines for these groups ¹. A new trend is the growing recommendation of singlepill combination therapies to improve medication adherence ¹. The use of newer technologies, like validated wearable devices for screening and monitoring, is also emerging as a future direction toward more continuous and patient-centered blood pressure care ¹. The differing recommendations on blood pressure targets for older adults and patients with CKD highlight areas where more research and consensus are needed ¹.

7. Recommendations for clinical practice and future research

Health professionals should be aware of the specific guidelines that apply to their region and patient population ¹. A personalized 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 out-of-office blood pressure monitoring should be emphasized ¹. Ongoing patient education and support to encourage lifestyle changes and medication adherence are essential ¹. Future research priorities include studies to clarify optimal blood pressure targets in specific groups such as very old, frail people and those with complex comorbidities ¹. More research is needed to assess the long-term effects of adopting lower diagnostic thresholds for hypertension ¹. Studies evaluating the effectiveness and cost-effectiveness of newer technologies for blood pressure measurement and management are required ¹. Further work to improve global harmonization of hypertension guidelines is also desirable ¹. Additional research is needed to study the impact of blood pressure management on pregnancy outcomes with lower blood pressure targets ¹. Studies on optimal blood pressure goals for children and adolescents that consider long-term cardiovascular outcomes are likewise necessary ¹.

8. Conclusion

Global blood pressure guidelines for 2025 paint a complex picture that shows both areas of agreement and significant differences ¹. Following evidence-based clinical guidance is essential for effective management of high blood pressure and to prevent related cardiovascular complications ¹. Health professionals need to recognize both the common ground andperhaps more importantlythe nuances and differences between recommendations from various international medical societies ¹. Applying these global guidelines requires careful consideration of individual patient characteristics, including age, existing comorbidities, overall cardiovascular risk profile and the specific context of the local health-care environment ¹. As hypertension research continues to evolve, guidelines will likely undergo further revisions and updates ¹. Therefore, ongoing professional development and a commitment to staying up-to-date with the latest evidence are key to providing optimal, patient-centered care for this widespread and important health condition ¹.

9. Appendix

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

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Guideline	Definition of hypertension (General adult population)	Blood pressure target (General adult population)	Blood pressure target (People with diabetes)	Blood pressure target (CKD patients)	Blood pressure target (Older adults)	Blood pressure target (Pregnant women)	Definition of hypertension (Adolescents ≥13 years)	Blood pressure target (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 (with proteinuria), <140/90 mmHg (without 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 (lowmoderate risk), <130/80 mmHg (high risk)	<130/80 mmHg (high risk), <140/90 mmHg (lowmoderate 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 Comment 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	140–150 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 individualized for frail/demented 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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