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CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e124 2 DEFINITIONS AND CLASSIFICATION OF BP 2.1 Definition of High BP Recommendation for Definition of High BP References that support the recommendation are summarized in the Evidence Table. COR LOE Recommendation 1 B-NR 1. In adults, BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP (Table 4).1,2 Synopsis Although a continuous and graded association exists between higher BP and CVD risk (Section 5.2.1, “Initia tion of Pharmacological BP Treatment in the Context of Overall CVD Risk”), it is useful to categorize BP levels for clinical and public health decision-making. In the present document, BP is categorized into 4 levels based on aver age BP measured in a health care setting (office BP): normal, elevated, and stage 1 or 2 hypertension (Table 4). The rationale for this categorization is based on ob servational data demonstrating the association between systolic blood pressure (SBP)/diastolic blood pressure (DBP) and CVD risk, as well as outcomes from RCTs of lifestyle modification to lower BP and RCTs of treatment with antihypertensive medication to prevent CVD. An in creasing number of individual studies and meta-analyses of observational data have reported a gradient of higher CVD risk from normal BP, to elevated BP, to stage 1 and 2 hypertension.2,3 BP categories are used for recommen dations for prevention and treatment, as are provided in Section 5 (“BP Management”). The relationship of this classification schema with measurements obtained by out-of-office BP monitoring, including ambulatory blood pressure measurement (ABPM) and home blood pres sure measurement (HBPM), is discussed in Sections 3.1.1 (“Accurate Measurement of In-Office BP”), 3.1.3 (“Out-of-Office BP Monitoring”), and 3.1.4 (“ABPM and HBPM”). Recommendation-Specific Supportive Text 1 The choice and the naming of BP categories were based on a pragmatic interpretation of BP-related CVD risk and benefit of BP reduction in clinical trials. Meta-analyses of observational studies have demon strated that elevated BP and hypertension are asso ciated with a higher risk of CVD, end-stage kidney disease, subclinical atherosclerosis, and all-cause death.1,3,4 The recommended BP classification system is most valuable for untreated adults to make deci sions about strategies to prevent or treat high BP. However, it is also useful in assessing the success of interventions to reduce BP. 3 EVALUATION AND DIAGNOSIS Synopsis Hypertension is the most prevalent modifiable CVD risk factor and is the leading cause of death and disability worldwide, with an increasing burden over the last several decades.1,2 From 2017 to 2020, the prevalence of hypertension (defined as BP ≥130/80 mm Hg or receiving antihypertensive therapy) among adults in the United States was 46.7%, with the preva lence varying by age, sex, and race/ethnicity (Table 5).3 With aging, population SBP levels tend to rise steadily to the end of life, whereas DBP levels rise until the fifth decade of life, plateau for a decade, and Table 4. Categories of Blood Pressure in Adults* SBP DBP BP Category Normal <120 mm Hg and <80 mm Hg Elevated 120 to 129 mm Hg and <80 mm Hg Hypertension Stage 1 130 to 139 mm Hg or 80 to 89 mm Hg Stage 2 ≥140 mm Hg or ≥90 mm Hg BP indicates blood pressure (based on an average of ≥2 careful readings obtained on ≥2 occasions, as detailed in Section 3 (“Evaluation and Diagnosis”); DBP, diastolic blood pressure; and SBP, systolic blood pressure. *Adults with SBP and DBP in 2 categories should be designated to the higher BP category. This table excludes individuals who are pregnant (see Section 11.5, “Hypertension and Pregnancy”). Adapted with permission from Whelton et al.5 Copyright 2018 American College of Cardiology Foundation and American Heart Association, Inc. Table 5. Prevalence of Hypertension* Among US Adults Aged 18 to 80 Years, 2017 to 2020 Demographic group Prevalence Men Women Overall 49.5% (59.0 million) 43.9% (56.3 million) Age groups, y 18-29 20.3% 9.0% 30-44 39.6% 23.7% 45-59 57.4% 52.5% 60-74 70.7% 71.4% 75-80 83.7% 84.8% Racial and ethnic groups (age-adjusted) NH White 47.0% 39.0% NH Black 56.8% 56.7% NH Asian 49.8% 39.1% Hispanic 50.4% 36.3% Other 50.7% 47.9% *Hypertension defined as diagnosed hypertension, BP ≥130/80 mm Hg, or receiving antihypertensive therapy. Derived from NHANES.9 BP indicates blood pressure; and NH, non-Hispanic. Downloaded from http://ahajournals.org by on October 7, 2026