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Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010

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[2]

Blood pressure (BP) is categorized in four levels based on an average of two or more properly taken BP measurements on two or more occasions in a healthcare setting (office setting):

  • Normal BP: systolic BP <120 mmHg and diastolic BP <80 mmHg

  • Elevated BP: systolic BP 120-129 mmHg and diastolic BP <80 mmHg

  • Stage 1 hypertension: systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg

  • Stage 2 hypertension: systolic BP ≥140 mmHg or diastolic BP 90 mmHg

2024 European Society of Cardiology (ESC) guidelines for the management of elevated blood pressure and hypertension[1]​

Cut-offs for the definition of hypertension for specific measurements are as follows.

Office BP

  • Non-elevated BP: systolic BP <120 mmHg and diastolic BP <70 mmHg

  • Elevated BP: systolic BP 120-139 mmHg and diastolic BP 70-89 mmHg

  • Grade 1 hypertension: systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg

  • Grade 2 hypertension: systolic BP 160-179 mmHg and/or diastolic BP 100-109 mmHg

  • Grade 3 hypertension: systolic BP ≥180 mmHg and/or diastolic BP ≥110 mmHg

  • Isolated systolic hypertension: systolic BP ≥140 mmHg and diastolic BP <90 mmHg

  • Isolated diastolic hypertension: systolic BP <140 mmHg and diastolic BP ≥90 mmHg

Ambulatory BP

  • Systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg for 24-hour BP

  • Systolic BP ≥135 mmHg and/or diastolic BP ≥85 mmHg for daytime ambulatory BP and home BP

  • Systolic BP ≥120 mmHg and/or diastolic BP ≥70 mmHg for nighttime BP

Hypertension Canada's 2020 comprehensive guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children[76]

BP is assessed using the following four approaches:

  • Automated office BP: a displayed mean systolic BP ≥135 mmHg or diastolic BP ≥85 mmHg is high.

  • Non-automated office BP: a mean systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg is high, and a systolic BP between 130 and 139 mmHg and/or a diastolic BP between 85 and 89 mmHg is high-normal.

  • Ambulatory BP monitoring: patients can be diagnosed as hypertensive if the mean awake systolic BP is ≥135 mmHg or the diastolic BP is ≥85 mmHg, or if the mean 24-hour systolic BP is ≥130 mmHg or the diastolic BP is ≥80 mmHg.

  • Home BP monitoring: patients can be diagnosed as hypertensive if the mean systolic BP is ≥135 mmHg or the diastolic BP is ≥85 mmHg. If the office BP measurement is high and the mean home BP is <135/85 mmHg, it is advisable to either repeat home monitoring to confirm the home BP is <135/85 mmHg or perform 24-hour ambulatory BP monitoring to confirm that the mean 24-hour ambulatory BP monitoring is <130/80 mmHg and the mean awake ambulatory BP monitoring is <135/85 mmHg before diagnosing white-coat hypertension.

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