Recommendations Summary

HTN: Classification of Blood Pressure 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  HTN: Blood Pressure Measurement in Assessment

  Blood pressure measurement should be used to classify blood pressure as Normal, Prehypertension, or Hypertension (Stage 1 or Stage 2), to estimate risk for disease, and to identify treatment options. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).

  Rating: Consensus
  Imperative

  HTN: Blood Pressure Measurement in Monitoring and Evaluation

  Blood pressure measurement should be used to monitor and evaluate the effectiveness of therapy. Elevated blood pressure is associated with risk of damage to the heart (LVH, angina, MI, coronary artery disease, heart failure), brain (TIA, stroke, dementia), kidney (CKD), peripheral arteries, and eyes (retinopathy).

  Rating: Consensus
  Imperative

  • Risks/Harms of Implementing This Recommendation

    Taking blood pressure measurement may be harmful in the following circumstances:

    • Lymphedema, fistula or arterial venous graft in the arm 

  • Conditions of Application

    Blood pressure measurement should be taken following JNC 7 protocol. Lack of access to equipment or results of measurement may limit these recommendations.

  • Potential Costs Associated with Application

    Costs include purchasing blood pressure measurement equipment and personnel training.

  • Recommendation Narrative

    • In the JNC 7 report, a new classification including the term "prehypertension" was introduced for those with blood pressures ranging from 120 - 139 mmHg systolic and/or 80 - 89 mmHg diastolic based on new data on lifetime risk of hypertension and increase in risk of cardiovascular complications associated wtih blood pressure levels previously considered to be normal.
    • In the JNC 7 report, stage 2 and stage 3 hypertension were combined into a single stage 2 category, because the approach to management of both stages 2 and 3 was similar. 

  • Recommendation Strength Rationale

    The ADA Hypertension Expert Work Group concurs with the recommendations from the JNC 7,  regarding classification of blood pressure.

    •  Updated from The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Arch Intern Med 1997; 157:2413-46.

    • Published in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.  JAMA 2003;289:2560-71.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    The Seventh Report of the Joint National Commitee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, NIH Publication No. 04-5230, August 2004, produced by the National Heart, Lung and Blood Institute in cooperation with the National High Blood Pressure Education Program.

    Available at:   

    http://www.nhlbi.nih.gov/guidelines/hypertension/

    To access the pdf of the JNC 7, click here: 

    http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm