Hypertension
Course of Disease
Natural history of primary hypertension
Figure 1 outlines progression of the natural history of hypertensive cardiovascular disease. In a study of the natural history of hypertension in control groups, wide variability of the absolute risk of stroke and heart attack was noted, but the relation between number of events prevented and absolute risk was near-linear for both coronary heart disease and stroke1 (Figure 1).
The progression of primary hypertension is as follows2:
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Prehypertension in persons aged 10-30 years (by increased cardiac output)
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Early hypertension in persons aged 20-40 years (in which increased peripheral resistance is prominent)
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Established hypertension in persons aged 30-50 years
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Complicated hypertension in persons aged 40-60 years
Figure 1. Range of hypertensive cardiovascular disease from prehypertension to target-organ damage and end-stage disease
Progression from lifestyle to the onset of stroke and coronary heart disease (CHD)3
Lifestyle (modifiable) and genetic (unmodifiable) factors are key cardiovascular risk factors, especially higher BP (Figure 2).
Figure 2. Schema of the progression from lifestyle changes to the incidence of hypertension and CVD3
Clinical practice guidelines
The definition of arterial hypertension is based in all available guidelines on office blood pressure4.
2017 American College of Cardiology (ACC)–American Heart Association (AHA) guidelines4
| Systolic and diastolic BP, mmHg | ||
|---|---|---|
| Normal | <120 and <80 | |
| Increased | 120–129 and <80 | |
| Stage 1 | 130–139 or 80–89 | |
| Stage 2 | ≥140 or ≥90 | |
2018 European Society of Cardiology (ESC)–European Society of Hypertension (ESH) guidelines4
| Systolic and diastolic BP, mmHg | ||
|---|---|---|
| Optimal | <120 and <80 | |
| Normal | 120–129 or 80–84, or both | |
| High-normal | 130–139 or 85–89, or both | |
| Stage 1 | 140–159 or 90–99, or both | |
| Stage 2 | 160–179 or 100–109, or both | |
| Stage 3 | ≥180 or ≥110, or both | |
| Isolated systolic hypertension | ≥140 and <90 | |
2020 International Society of Hypertension (ISH) guidelines4
| Systolic and diastolic BP, mmHg | ||
|---|---|---|
| Normal | <130 and <85 | |
| High-normal | 130–139 or 85–89, or both | |
| Grade 1 hypertension | 140–159 or 90–99, or both | |
| Grade 2 hypertension | ≥160 or ≥100, or both | |
2020 The Taiwan Hypertension Society (THS) and the Taiwan Society of Cardiology (TSOC)5
Corresponding values of systolic and diastolic readings between office blood pressure (OBP) and home blood pressure (HBP)
| Classification | OBP, mmHg | HBP, mmHg |
|---|---|---|
| Normal blood pressure | ||
| Systolic | 120 | 120 |
| Diastolic | 80 | 80 |
| High normal blood pressure | ||
| Systolic | 130 | 130 |
| Diastolic | 80 | 80 |
| Stage I hypertension | ||
| Systolic | 140 | 135 |
| Diastolic | 90 | 85 |
| Stage II hypertension | ||
| Systolic | 160 | 145 |
| Diastolic | 100 | 90 |
| Stage III hypertension | ||
| Systolic | 180 | 160 |
| Diastolic | 110 | 100 |
Footnotes:
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ACC, American College of Cardiology; AHA, American Heart Association; BP, blood pressure; CHD, coronary heart disease; CVD, cardiovascular disease; ESC, European Society of Cardiology; ESH, European Society of Hypertension; HBP, home blood pressure; ISH, International Society of Hypertension; OBP, office blood pressure; THS, Taiwan Hypertension Society; TSOC, Taiwan Society of Cardiology.
References:
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Messerli FH, Williams B, Ritz E. Essential hypertension. Lancet. 2007;370(9587):591-603.
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What is the progression of essential hypertension (high blood pressure)? Medscape.
https://www.medscape.com/answers/241381-7582/what-is-the-progression-of-essential-hypertension-high-blood-pressure. Accessed 28 Aug 2021 -
Kokubo Y. Hypertension. 2014;63(4):655-660.
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Brouwers S, et al. Lancet. 2021;398(10296):249-261.
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Lin HJ, et al. Acta Cardiol Sin. 2020;36(6):537-561.