High Blood Pressure (Arterial Hypertension): Classification

The German Hypertension League e. V. (DHL) classifies hypertension according to systolic and diastolic blood pressure as follows:

Grade Systolic blood pressure (in mmHg) Diastolic blood pressure (in mmHg)
Optimal < 120 and < 80
Normal 120-129 and/or 80-84
High Normal 130-139 and/or 85-89
Hypertension, stage I (mild) 140-159 and/or 90-99
Hypertension; stage II (moderate) 160-179 and/or 100-109
Hypertension, stage III (severe) > 180 and/or ≥ 110
Isolated systolic hypertension (ISH). ≥ 140 and < 90

As a result of the SPRINT study, DHL recommends a blood pressure goal of < 135/85 mmHg for all cardiovascular risk patients. These include:

  • Patients with existing cardiovascular disease (excluding apoplexy/stroke patients).
  • Patients with chronic kidney disease stage 3 or greater (= GFR < 60 ml/min/1.73 m2).
  • Patients > 75 years

The target corridor should be 125 to 134 mmHg. The European Society of Hypertension (ESH) classifies hypertension according to systolic and diastolic blood pressure as follows [guidelines: 2]:

Grade Systolic blood pressure (in mmHg) Diastolic blood pressure (in mmHg)
Optimal < 120 and < 80
Normal 120-129 and/or 80-84
High Normal 130-139 and/or 85-89
Hypertension, stage I (mild) 140-159 and/or 90-99
Hypertension; stage II (moderate) 160-179 and/or 100-109
Hypertension, stage III (severe) > 180 and/or ≥ 110
Isolated systolic hypertension (ISH). ≥ 140 and < 90

The American Heart Association (AHA) and American College of Cardiology Guidelines (ACC) has adopted a new hypertension classification (November, 2017) [Guidelines: 1]:

Grade Systolic blood pressure (in mmHg) Diastolic blood pressure (in mmHg)
Optimal (normal) < 120 and < 80
Increased blood pressure 120-129 and < 80
Hypertension, level 1 130-139 and/or 80-89
Hypertension, stage II ≥ 140 and/or ≥ 90

Hypertensive crisis

Hypertensive crisis >180/120 mmHg
Hypertensive emergency > 230/120 m mHg or any elevated value with life-threatening organ damage
Malignant hypertension Diastolic blood pressure > 120 mmHg* .

* with abolished day-night rhythm, hypertensive retinopathy (blood pressure-related retinal disease), and development of renal insufficiency (kidney weakness)

Threshold values of hypertension in practice-independent measurements

Method Systolic (in mmHg) Diastolic (in mmHg)
Practice/clinic blood pressure measurement ≥ 140 ≥ 90
Home blood pressure self-monitoring (HBPM). ≥ 135 ≥ 85
Long-term blood pressure measurement (ambulatory blood pressure monitoring, ABDM).
  • Daily mean
 ≥ 135 ≥ 85
  • Night average
 ≥ 120 ≥ 75
  • 24-h average
 ≥ 130 ≥ 80

Therapy-refractory arterial hypertension (TRH)

Refractory arterial hypertension (TRH) is said to occur when the therapeutic goal is not achieved despite adequate doses of medication with at least three antihypertensives from different groups, including a diuretic. Note: In the presence of TRH, secondary hypertension, especially renal artery stenosis and pheochromocytoma, must be excluded with certainty. TRH exists if, with guideline-guided therapy, blood pressure is as follows:

  • > 140/90 mmHg in general
  • > 130-139/80-85 mmHg in patients with diabetes mellitus.
  • > 130/80 mmHg in patients with chronic kidney disease.