Harmonized Normal Blood Pressure Values from Tensana

Tensana uses harmonized normal values in the app and web version. To establish these values, we compared international recommendations and thresholds and used them to derive a standardized table for classifying blood pressure readings.

If you are looking for a quick overview, you can find it in our blood pressure chart by age. On this page, we explain how the harmonized values were derived and how they are used.

Introduction

To provide a consistent and easy-to-understand basis for assessing blood pressure, we have developed a globally harmonized table of normal values. Because blood pressure guidelines and target values sometimes differed and could vary from country to country, there was often confusion about when blood pressure is considered normal, elevated, or in need of treatment. Our internationally harmonized table helps classify blood pressure using standardized categories, providing all users with transparent and reliable guidance.

1. Summary

An overview of global organizations concerned with blood pressure

Hypertension is a global health problem of considerable magnitude and a major risk factor for cardiovascular disease. Clear and consistent guidelines for diagnosing and treating high blood pressure are essential to support healthcare professionals in clinical practice worldwide. This report provides a comparative analysis of the latest available 2025 guidelines from leading medical societies in North America, Europe, South America, Africa, Asia, Australia, and New Zealand. It presents a harmonized overview of blood pressure classifications and highlights the key differences in recommended target values for specific patient groups. While there is a general consensus on the basic blood pressure categories, there are significant variations in diagnostic thresholds and treatment targets, reflecting regional differences in population characteristics, healthcare systems, and evolving clinical evidence. An important trend observed in many guidelines is the recommendation of lower blood pressure targets, particularly for people with diabetes, chronic kidney disease, and established cardiovascular disease. This development underscores the importance of intensive treatment in these high-risk groups. The diversity of guidelines from different regions and medical societies points to a complex landscape that may be confusing for clinicians. This report aims to provide clarity and a basis for a better understanding of global differences and similarities in hypertension management. The tendency of many medical societies to pursue lower blood pressure targets, particularly in high-risk patients, is a crucial aspect that underscores the need for early and intensive intervention.

2. Introduction

The global prevalence of high blood pressure poses a significant threat to public health and contributes substantially to increased morbidity and mortality from cardiovascular events such as stroke, myocardial infarction, and kidney failure ¹. In response to this challenge, numerous medical societies have made considerable efforts to develop and disseminate clinical guidelines for the prevention, detection, assessment, and treatment of high blood pressure. Based on the latest scientific evidence, these guidelines serve as important resources for healthcare providers to standardize clinical practice and optimize patient outcomes. This report aims to provide a comprehensive and harmonized overview of the current landscape of global normal blood pressure values for adults in 2025. By examining the latest recommendations from major medical societies in North America, Europe, South America, Africa, Asia, Australia, and New Zealand, this analysis aims to shed light on both the consensus and the differences in their approaches to defining and treating hypertension. The methodology for this report included a thorough review and synthesis of the latest hypertension guidelines published by major medical organizations in the geographical regions mentioned above. It should be noted that the constantly evolving evidence base and better understanding of regional healthcare needs are leading to the ongoing refinement of these guidelines. The inclusion of blood pressure measurement in children and adolescents is also considered an important aspect, particularly given the rising rates of obesity in this age group worldwide ¹. The continuous updating of guidelines underscores the need for clinicians to stay up to date with the latest recommendations and to individualize treatment strategies based on a comprehensive assessment of each patient's individual profile.

3. Harmonized Global Blood Pressure Classifications: A Detailed Analysis

The following table presents a harmonized classification of blood pressure categories in adults, compiled from the guidelines of various international medical societies ¹:

Category	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)
Low	<105	<65
Optimal	105–119	65–79
Normal	120–129	80–84
High-normal / Elevated	130–139	85–89
Grade 1 hypertension	140–159	90–99
Grade 2 hypertension	160-179	100-109
Grade 3 hypertension	>=180	>=110

Notes:
There are no standard values for low blood pressure. However, we do not want to describe low values as “optimal.” Please also note that, according to some guidelines, a blood pressure of >=135 and/or >=85 mmHg in home measurements is considered high blood pressure. For example, the European Society of Hypertension (ESH) guidelines recommend this cut-off as the threshold for diagnosing hypertension based on home blood pressure measurements. The German Hypertension League (DHL) follows this recommendation. In Canada, too, guidelines such as those of the Canadian Hypertension Education Program (CHEP) commonly use a threshold of 135/85 mmHg for home measurements.

Explanation:
This harmonized table serves as a simplified, general framework for understanding blood pressure categories. However, it is important to emphasize that individual medical societies often use different classification systems, with variations in terminology and specific numerical thresholds ¹. For example, the 2017 guideline from the American Heart Association (AHA) and the American College of Cardiology (ACC) in North America redefined hypertension using a lower threshold of ≥130/80 mmHg and introduced the category “Elevated blood pressure” for values between 120–129/<80 mmHg ¹. This change was based on a growing understanding of the increased cardiovascular risk associated with blood pressure values previously considered prehypertensive ¹. Similarly, the 2024 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) also introduced an “Elevated blood pressure” category, defined as 120–139/70–89 mmHg ¹, while retaining the hypertension threshold of ≥140/90 mmHg ¹. The 2019 guidelines from the Japanese Society of Hypertension (JSH) use terms such as “High-normal blood pressure” (120–129/<80 mmHg) and “Elevated blood pressure” (130–139/80–89 mmHg), aligning their blood pressure thresholds with those in the US guidelines ¹⁸. The 2022 focused update of the 2018 Korean guidelines (Korean Society of Hypertension, KSH) provides its own classification system ²³, while the 2024 Chinese guidelines (Chinese Hypertension League, CHL) continue to use 140/90 mmHg as the diagnostic threshold for hypertension ²⁴. The harmonized table serves as a useful initial reference, but a comprehensive understanding requires a detailed review of the specific guidelines issued by medical societies in different regions. The differing definitions of hypertension used by leading medical societies highlight the need for clinicians to be aware of regional differences and adapt their diagnostic and therapeutic approaches accordingly.

4. Regional and society-specific blood pressure guidelines: A comparative overview

North America:

The 2017 guideline from the American Heart Association (AHA) and the American College of Cardiology (ACC) defined hypertension as a blood pressure of ≥130/80 mmHg, a significant change from the previous threshold of 140/90 mmHg ¹. This guideline also eliminated the category “Prehypertension” and replaced it with “Elevated blood pressure” for systolic values between 120–129 mmHg and diastolic values below 80 mmHg ¹. The recommendations emphasize a risk-based approach to treatment and suggest a target blood pressure of <130/80 mmHg for adults with confirmed hypertension and existing cardiovascular disease or a 10-year risk of atherosclerotic cardiovascular disease (ASCVD) of 10 % or higher ¹. The AHA and ACC also promote the “Target: BP” initiative to improve blood pressure control rates ¹. The AHA/ACC's aggressive approach to defining and treating hypertension reflects a strong commitment to early intervention to reduce cardiovascular risk.
In its Standards of Medical Care in Diabetes (2024), the American Diabetes Association (ADA) recommends a target blood pressure of <130/80 mmHg for people with diabetes who have a higher cardiovascular risk ³¹. A target of <140/90 mmHg continues to be recommended for many other adults with diabetes ³¹. The ADA's differentiated targets underscore the importance of risk stratification when treating hypertension in people with diabetes.
The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guideline for blood pressure management in chronic kidney disease (CKD) suggests a target systolic blood pressure of <120 mmHg for most adults with CKD, if tolerated ³⁵. This recommendation reflects a more intensive approach to blood pressure control in this high-risk population. KDIGO's very low systolic target indicates the high cardiovascular risk and risk of kidney disease progression in this patient group.
For hypertension during pregnancy, the 2019 guidelines of the American College of Obstetricians and Gynecologists (ACOG) define hypertension as a blood pressure of ≥140/90 mmHg ²⁷. ACOG recommends using antihypertensive treatment to keep blood pressure below 160/110 mmHg during pregnancy ²⁷. ACOG's higher threshold for treating hypertension during pregnancy reflects the need to consider fetal perfusion.

Europe:

The 2024 guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) define hypertension as a blood pressure of ≥140/90 mmHg ¹. For most adults receiving antihypertensive medication, these guidelines recommend a target systolic blood pressure range of 120–129 mmHg, provided that treatment is well tolerated ¹. The ESC/ESH guidelines also specify age-specific blood pressure targets for older people ¹. The ESC/ESH approach is somewhat more conservative than that of the AHA/ACC in defining hypertension, but it still advocates lower targets.

South America:

The material provided indicates guidelines from the Sociedad Interamericana de Hipertensión (SIH), Sociedad Argentina de Hipertensión Arterial (SAHA) and Sociedade Brasileira de Cardiologia (SBC). However, specific details of their latest recommendations on blood pressure classifications and targets are not covered extensively in the research provided ⁵⁸. The Inter-American Society of Cardiology (IASC) suggests using the blood pressure classification of the Latin American Society of Hypertension (LASH) ⁶². The 2017 LASH guidelines retain the conventional definition of hypertension as ≥140/90 mmHg ⁶².

Africa:

In 2021, the Pan-African Society of Cardiology (PASCAR) published a commentary on the International Society of Hypertension's (ISH) 2020 global hypertension practice guidelines ¹. PASCAR's approach emphasizes resource-stratified recommendations for hypertension management across the continent ⁷¹. PASCAR proposes a classification that defines hypertension as ≥140/90 mmHg ⁷⁸.
The 2014 guidelines of the Southern African Hypertension Society (SAHS) define hypertension as persistently elevated office blood pressure of ≥140/90 mmHg ⁷¹. SAHS recommends a universal target of <140/90 mmHg for antihypertensive treatment ⁷¹.

Asia:

The 2019 guidelines of the Japanese Society of Hypertension (JSH) define hypertension as ≥140/90 mmHg ¹⁸. The recommended target office blood pressure is <130/80 mmHg for adults under 75 years of age and <140/90 mmHg for people aged 75 years and older ¹⁸. The 2019 JSH guidelines are largely aligned with the US guidelines regarding blood pressure thresholds.
The 2022 focused update of the 2018 Korean guidelines (Korean Society of Hypertension, KSH) generally recommends a target blood pressure of <140/90 mmHg, with a more intensive target of <130/80 mmHg for high-risk patients ²³. The KSH guidelines differentiate blood pressure targets according to patients' cardiovascular risk.
The 2024 guidelines of the Chinese Hypertension League (CHL) retain the diagnostic threshold for hypertension at 140/90 mmHg, but recommend a target blood pressure of <130/80 mmHg for most people, if tolerated ²⁴. The CHL guidelines are moving toward lower target blood pressure levels, similar to those in other regions.
Experts at the 76th Annual Conference of the Cardiological Society of India (CSI) presented new hypertension management guidelines in 2024 that emphasize an ideal blood pressure below 120/80 mmHg ⁹⁹. Slightly higher values may be acceptable for people over 80 years of age ⁹⁹. The CSI guidelines appear to aim for a very strict ideal blood pressure.

Australia and New Zealand:

The 2016 guidelines of the National Heart Foundation of Australia (NHF) define hypertension as an office blood pressure of 140/90 mmHg or higher ⁶. They recommend a target of <140/90 mmHg, with lower targets (<120 mmHg systolic) considered appropriate for high-risk groups if well tolerated ⁶. The National Hypertension Taskforce aims to increase blood pressure control rates to 70 % by 2030 ¹⁰².
The 2018 consensus statement of the Cardiac Society of Australia and New Zealand (CSANZ) and the New Zealand Ministry of Health recommends individualizing blood pressure targets based on cardiovascular disease risk ¹. For people at high CVD risk, the target is <130/80 mmHg, while <140/90 mmHg applies to those at lower risk ¹. The guidelines in Australia and New Zealand increasingly emphasize the importance of cardiovascular risk assessment in guiding blood pressure targets.
The 2023 guidelines of the Society of Obstetric Medicine Australia and New Zealand (SOMANZ) define hypertension in pregnancy as ≥140/90 mmHg and recommend a target blood pressure of ≤135/85 mmHg ⁷¹.

5. Blood Pressure Management in Special Patient Groups: A Global Perspective

Patients with Diabetes Mellitus: The guidelines generally recommend a target blood pressure of <140/90 mmHg for most patients with diabetes ³¹. However, many professional societies, including the ADA, JSH, KSH, and CSI, suggest a stricter target of <130/80 mmHg for patients at high cardiovascular risk ³¹. Preferred antihypertensive medications often include ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics ¹.
Patients with Chronic Kidney Disease (CKD): The KDIGO guideline recommends a target systolic blood pressure of <120 mmHg ³⁵, while the ESC/ESH suggests <140/90 mmHg (with <130/80 mmHg if tolerated) ³⁵. Other guidelines, such as those from the JSH, KSH, CHL, NHF, and CSANZ/NZ, also generally recommend targets around <130/80 mmHg ³⁵. ACE inhibitors and ARBs are often preferred ¹.
Older Adults: Blood pressure targets for older adults vary considerably ¹. The ESC/ESH recommends <140/80 mmHg for those aged 65 to 79 and a systolic blood pressure of 140–150 mmHg for those aged ≥80 ¹. The AHA/ACC suggests <130/80 mmHg while taking frailty into account ¹. The JSH targets <140/90 mmHg for those aged ≥75 ⁵⁸. The CSI recommends <135/80 mmHg for those over 80 ⁴. The NHF targets a systolic blood pressure of <120 mmHg for those aged ≥75, if tolerated ¹⁴².
Pregnant Women: The ESC/ESH and CSI recommend a target of <140/90 mmHg ¹. SOMANZ suggests ≤135/85 mmHg ⁷¹. ACOG recommends <160/110 mmHg ¹¹.
Children and Adolescents: The AHA defines hypertension as ≥130/80 mmHg for those aged ≥13 and as the ≥95th percentile for younger children ¹⁰. The ESC uses ≥140/90 mmHg for those aged ≥16 and the ≥95th percentile for younger children ¹⁴. The KSH uses ≥140/90 mmHg for those aged ≥17 and the ≥95th percentile for younger people ¹⁵⁴. The NHF uses ≥120/80 mmHg for those aged ≥13 and the ≥95th percentile for younger people ¹⁷.
Patients with Cardiovascular Disease (CHD, Stroke): In general, a target of <130/80 mmHg is recommended for patients with stroke ¹, coronary heart disease ¹, and heart failure ⁴.

6. Key Differences, Similarities, and Emerging Trends in Global Hypertension Guidelines

A key difference between global guidelines is the threshold for diagnosing hypertension, with the AHA/ACC endorsing a lower threshold of 130/80 mmHg compared with the ESC/ESH, JSH, and CHL, which retain the traditional threshold of 140/90 mmHg ¹. Despite this difference, there is strong consensus across all guidelines on the fundamental role of lifestyle changes, including dietary changes, regular physical activity, weight management, and smoking cessation, as cornerstones of hypertension management ¹. A notable trend observed across different regions is the increasing adoption of lower blood pressure targets, particularly for people identified as being at high risk of cardiovascular events, such as patients with diabetes, chronic kidney disease, or a history of stroke or heart attack ¹. This shift is largely due to the growing body of evidence from clinical trials demonstrating the benefits of more intensive blood pressure control in these populations ¹. In addition, increasing emphasis is being placed on the importance of blood pressure measurement outside the doctor's office, including both home and ambulatory blood pressure monitoring, for more accurate diagnosis and effective long-term management of hypertension ¹. Finally, hypertension in specific populations, such as children, adolescents, and pregnant women, is receiving increasing attention, leading to the development of more specific guidelines for these groups ¹. An emerging trend is the increasing recommendation of single-pill combination therapies to improve medication adherence ¹. The incorporation of newer technologies, such as validated wearable devices for screening and monitoring, is also emerging as a future direction for more continuous and patient-centered blood pressure management ¹. The differing recommendations on blood pressure targets for older adults and patients with CKD highlight areas where further research and consensus are needed ¹.

7. Recommendations for Clinical Practice and Future Research

Healthcare professionals should be aware of the specific guidelines relevant to their region and patient population ¹. A personalized approach to blood pressure management is recommended, taking into account individual risk factors, comorbidities, and patient preferences ¹. Accurate blood pressure measurement techniques and the role of blood pressure measurement outside the doctor's office should be emphasized ¹. Ongoing patient education and support to promote lifestyle changes and medication adherence are essential ¹. Future research should include studies to further clarify optimal blood pressure targets in specific populations, such as the very old, frail individuals, and people with complex comorbidities ¹. Further research is needed to evaluate the long-term effects of introducing lower diagnostic thresholds for hypertension ¹. Studies assessing the effectiveness and cost-effectiveness of newer technologies for blood pressure measurement and treatment are required ¹. Further investigation of strategies to improve the global harmonization of hypertension guidelines is also desirable ¹. Additional research is needed to investigate the effects of blood pressure management with lower blood pressure targets on pregnancy outcomes ¹. Studies of optimal blood pressure targets in children and adolescents that consider long-term cardiovascular outcomes are also needed ¹.

8. Conclusion

The global blood pressure guidelines for 2025 present a complex picture, reflecting both areas of consensus and significant differences ¹. Adherence to evidence-based clinical guidelines is of paramount importance for the effective management of hypertension and the prevention of its associated cardiovascular complications ¹. Healthcare professionals must recognize the similarities and, more importantly, the nuances and differences among the recommendations of various international medical societies ¹. Applying these global guidelines requires careful consideration of individual patient characteristics, including age, existing comorbidities, overall cardiovascular risk profile, and the specific context of the regional healthcare environment ¹. As the field of hypertension research continues to evolve, the guidelines are likely to undergo further revisions and updates ¹. Therefore, ongoing professional development and a commitment to staying up to date with the latest evidence are crucial to providing optimal, patient-centered care in the management of this widespread and significant health condition ¹.

9. Appendix

Table 2: Comparison of Blood Pressure Classifications and Treatment Targets in Major Global Guidelines

Guideline	Definition of Hypertension (General Adult Population)	Target Blood Pressure (General Adult Population)	Target Blood Pressure (Patients with Diabetes)	Target Blood Pressure (Patients with CKD)	Target Blood Pressure (Older Adults)	Target Blood Pressure (Pregnant Women)	Definition of hypertension (adolescents ≥13 years)	Target blood pressure (patients with CVD)
AHA/ACC (2017)	≥130/80 mmHg	<130/80 mmHg	<130/80 mmHg	<130/80 mmHg	<130/80 mmHg	≥140/90 mmHg, treatment at ≥160/110 mmHg	≥130/80 mmHg	<130/80 mmHg
ESC/ESH (2024)	≥140/90 mmHg	120–129 mmHg systolic	<130/80 mmHg	<140/90 mmHg (<130/80 if tolerated)	<140/80 mmHg (65–79), 140–150 systolic (≥80)	<140/90 mmHg	≥140/90 mmHg (≥16 years)	<130/80 mmHg
JSH (2019)	≥140/90 mmHg	<130/80 mmHg (<75 years), <140/90 mmHg (≥75 years)	<130/80 mmHg	<130/80 mmHg (proteinuria +), <140/90 mmHg (proteinuria –)	<140/90 mmHg (≥75 years), <130/80 mmHg (<75 years if tolerated)	≥140/90 mmHg	≥130/80 mmHg	<130/80 mmHg
KSH (2022)	≥140/90 mmHg	<140/90 mmHg (low-to-moderate risk), <130/80 mmHg (high risk)	<130/80 mmHg (high risk), <140/90 mmHg (low-to-moderate risk)	<130/80 mmHg (with albuminuria), <140/90 mmHg (without albuminuria)	<140/90 mmHg (≥65 years)	≥140/90 mmHg, treatment at ≥160/90 mmHg	≥130/80 mmHg	<130/80 mmHg
CHL (2024)	≥140/90 mmHg	<130/80 mmHg (if tolerated)	<130/80 mmHg (if tolerated)	<130/80 mmHg (if tolerated)	<150 mmHg systolic (65–79), <150 mmHg systolic (≥80)	≥140/90 mmHg	≥140/90 mmHg	<130/80 mmHg (if tolerated)
PASCAR (2021 Commentary on ISH 2020)	≥140/90 mmHg	<140/90 mmHg	<130/80 mmHg	<130/80 mmHg	<150/90 mmHg systolic (≥80 years)	≥140/90 mmHg	≥140/90 mmHg	<130/80 mmHg
SAHS (2014)	≥140/90 mmHg	<140/90 mmHg	<140/90 mmHg	<140/90 mmHg	140–150 mmHg systolic (≥80 years if systolic >160)	≥140/90 mmHg	N/A	<140/90 mmHg
NHF (2016)	≥140/90 mmHg	<140/90 mmHg (<120 systolic if high risk)	<130/80 mmHg	<120 mmHg systolic	<120 mmHg systolic (≥75 years if tolerated)	≥140/90 mmHg	≥140/90 mmHg	<120 mmHg systolic
CSANZ/NZ (2018)	≥140/90 mmHg	<140/90 mmHg (lower risk), <130/80 mmHg (high risk)	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)	<140/90 mmHg (lower risk), targets individualized for patients with frailty/dementia	≥140/90 mmHg, treatment at ≥160/100 mmHg, target ≤135/85 mmHg	≥130/80 mmHg	<130/80 mmHg (high risk), <140/90 mmHg (lower risk)

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