Grades and stages of high blood pressure
High blood pressure (hypertension) is one of the most common diseases in Western societies. Among people over 45, the hypertension rate is already almost 50 percent-and rising.
High blood pressure means increased pressure in the arteries. By definition, blood pressure is considered normal if it is below 130/85. It is still considered high-normal at values below 139/89 mmHg. Although blood pressure can fluctuate considerably in different situations and values certainly vary from person to person, a sustained blood pressure reading above 140/90 mmHg is considered high blood pressure.
Grade 1 hypertension refers to mild hypertension with systolic values between 140 and 159 mmHg and/or diastolic values between 90 and 99 mmHg. Although it's often called "mild hypertension," these values are already elevated and should not be taken lightly.
In consultation with your treating doctor, lifestyle changes may already be enough to bring the values back into the normal range; however, sometimes medication is necessary.
Please note that, according to the German Hypertension League's guidelines, a home blood pressure measurement of >=135 and/or >=85 mmHg is considered high blood pressure.
Grade 2 hypertension already shows clearly elevated blood pressure values between 160-179 mmHg systolic and/or 100-109 mmHg diastolic. At this stage, medication is essential in addition to the lifestyle changes already mentioned above.
Grade 3 hypertension is present when systolic pressure is at or above 180 mmHg and/or diastolic pressure is at or above 110 mmHg. Regardless of the stage of hypertension, there is a high risk of cardiovascular complications. To reduce this risk, medication is urgently needed alongside an appropriate lifestyle.
| Hypertension - disease stage |
Other risk factors, HMOD, CVD or CKD |
Blood pressure classification
(mmHg) | |||
|---|---|---|---|---|---|
| High-normal SBP 130-139 DBP 85-89 | Grade 1 SBP 140-159 DBP 90-99 | Grade 2 SBP 160-179 DBP 100-109 | Grade 3 SBP ≥ 180 or DBP ≥ 110 | ||
| Stage 1 | No additional risk factorsa | Low risk | Low risk | Moderate risk | High risk |
| 1 to 2 risk factors | Low risk | Moderate risk |
Moderate to high risk |
High risk | |
| ≥ 3 risk factors |
Low to moderate risk |
Moderate to high risk |
High risk | High risk | |
| Stage 2 |
HMOD, stage 3 CKD or diabetes mellitus |
Moderate to high risk |
High risk | High risk | Very high risk |
| Stage 3 | Established CVD or CKD stage ≥ 4 | Very high risk | Very high risk | Very high risk | Very high risk |
Source: 2023 ESC/ESH Guideline
| < 50 years | 60-69 years | > 70 years |
Additional risk assessment in stage 1 using SCORE2/SCOR2-OP |
|
|---|---|---|---|---|
| < 2.5% | < 5% | < 7.5% | ||
| 2.5% to < 7.5% | 5 to 10% | 7.5% to < 15% | ||
| ≥ 7.5% | ≥ 10% | ≥ 15% |
Further information and explanations of the abbreviations can be found in the ESH Guidelines.
The WHO also divides hypertension, that is, high blood pressure, into three stages:
- Stage I = no organ changes
- Stage II = with organ involvement - enlarged left side of the heart (left ventricular hypertrophy), mild blood-pressure-related changes in the retina (retinopathy), mild blood-pressure-related kidney damage (proteinuria)
asymptomatic, i.e., the person does not yet notice the existing damage - Stage III = hypertensive organ damage - left-sided heart failure (the heart no longer pumps at full strength), damage to the central nervous system, more advanced retinal changes with bleeding, and renal insufficiency
at this stage the damage is usually noticeable to the affected person
Sources:
- https://www.gbe-bund.de/gbe/abrechnung.prc_abr_test_logon?p_uid=gast&p_aid=0&p_knoten=FID&p_sprache=D&p_suchstring=11737#Kap3.1
- https://www.hochdruckliga.de/fileadmin/downloads/mediziner/leitlinien/Pocket-Leitlinie_Hypertonie_2018.pdf
- https://journals.lww.com/jhypertension/Fulltext/9900/2023_ESH_Guidelines_for_the_management_of_arterial.271.aspx
This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2025).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
