Chronic hypertension classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri, Yazan Daaboul, Serge Korjian

Overview

Blood pressure values for adults have been classified in 2004 according to the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure into normal, prehypertension, stage 1 hypertension and stage 2 hypertension. In Europe, a different classification of blood pressure has been conducted in 2007 by “The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)”. The classification excludes JNC 7’s pre-hypertension category, but includes 3 different grades of hypertension, in contrast to JNC 7’s two-stage classification of hypertension.

Classification

JNC 7 Classification of Blood Pressure or Adults

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure as the following:

Blood Pressure Classification	Systolic (mm Hg)		Diastolic (mm Hg)
Normal	< 120	and	< 80
Pre-Hypertension	120-139	or	80-89
Stage 1 Hypertension	140-159	or	90-99
Stage 2 Hypertension	>160	or	>100

European Classification of Blood Pressure

In Europe, a different classification of blood pressure has been conducted in 2007 by The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). According to the 2007 Guidelines for the Management of Arterial Hypertension, the blood pressure classification is as follows:

Blood Pressure Classification	Systolic (mm Hg)		Diastolic (mm Hg)
Optimal	< 120	and	< 80
Normal	120-129	and/or	80-84
High Normal	130-139	and/or	85-89
Grade 1 Hypertension	140-159	and/or	90-99
Grade 2 Hypertension	160- 179	and/or	100-109
Grade 3 Hypertension	≥ 180	and/or	≥ 110
Isolated Systolic Hypertension	≥ 140	and	<90

Classification of Pathophysiology

Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.

• Over 90% of adult hypertension has no clear cause and is therefore called essential/primary hypertension. Often, it is part of the metabolic "syndrome X" in patients with insulin resistance: it occurs in combination with diabetes mellitus (type 2), combined hyperlipidemia and central obesity.
• Secondary hypertension is more common in pre-adolescent children, with most cases caused by renal disease.

Essential Hypertension

Essential hypertension is the most prevalent type of hypertension type, and affects 90-95% of hypertensive patients. Although there are risk factors for essential hypertension (sedentary lifestyle, obesity, increased salt intake, increased alcohol intake), by definition there is no other disease state responsible for the occurrence of the elevated blood pressure.

Secondary Hypertension

Secondary hypertension results from an identifiable cause. Recognition of secondary hypertension is critical since the management is different than primary or essential hypertension and involves treatment of the underlying cause of the elevated blood pressure. Underlying disorders that account for secondary hypertension include: