Why blood pressure matters
Hypertension is a major modifiable risk factor for stroke, heart attack, heart failure and chronic kidney disease. It often causes no symptoms, so regular measurement is more reliable than simply feeling well. Cardiovascular risk rises progressively with blood pressure and also depends on age, diabetes, smoking, blood lipids and kidney function.
Understanding the readings
The 2024 European Society of Cardiology (ESC) guidelines define hypertension in adults as office systolic blood pressure of at least 140 mmHg or diastolic blood pressure of at least 90 mmHg. They also introduce an elevated blood pressure category: systolic values of 120–139 mmHg or diastolic values of 70–89 mmHg, below the hypertension threshold. Diagnostic thresholds depend on how readings are taken. At home, an average of at least 135/85 mmHg is generally indicative of hypertension. A single reading is usually insufficient to establish the diagnosis.
European and US guidelines use different definitions
The US AHA/ACC 2025 guideline classifies systolic pressure of 130–139 mmHg or diastolic pressure of 80–89 mmHg as stage 1 hypertension. Its general treatment goal is below 130/80 mmHg, with individual exceptions. This guide uses the ESC framework described above: a diagnostic threshold and a treatment target answer different questions and should not be confused.
AHA/ACC 2025 — guideline summary and original publication
Measurement is part of the diagnosis
Use a validated automatic upper-arm monitor and an appropriately sized cuff. Sit with your back and arm supported, keep your feet on the floor, and rest for five minutes before taking a reading. Take repeated measurements and record the date, time and results. Home or 24-hour monitoring can identify white-coat hypertension and masked hypertension.
Read the practical guide to measuring blood pressure →
Risk is different for each person
Clinical assessment considers organ damage, cardiovascular disease, albuminuria, impaired kidney function and other risk factors. Selected patients need investigation for secondary causes, particularly when hypertension begins early, remains resistant to treatment or is accompanied by specific clinical clues.
Lifestyle and treatment
Reducing excess salt, eating a balanced diet, exercising regularly, limiting alcohol, avoiding smoking and addressing excess weight can help control blood pressure. Antihypertensive medicines, often used in combination, are added when readings and risk warrant them. Treatment choices depend on other conditions, tolerability and contraindications.
For many adults receiving treatment, the 2024 ESC guidelines propose a systolic target of 120–129 mmHg if well tolerated. Frail older adults, people with orthostatic hypotension and those who do not tolerate treatment require individualised targets.
Very high readings without symptoms
If systolic pressure is above 180 mmHg or diastolic pressure above 120 mmHg without warning symptoms, repeat the measurement after at least one minute. Persistently very high readings require immediate contact with a healthcare professional. Symptoms suggesting acute heart, brain or other organ injury require emergency assessment; the blood pressure number alone does not distinguish these situations.
Long-term control
Successful care depends on more than the reading taken during an appointment. Sustained blood pressure control, adherence to treatment and prevention of complications are also essential. Regular reassessment allows targets to be adapted to the person’s changing circumstances.
Related prevention guides
Review how to measure blood pressure accurately, then explore overall cardiovascular risk and metabolic syndrome and CKM health. The heart failure guide explains another important aspect of cardiovascular care.
About Massimo Fioranelli · Cardiology and internal medicine · Clinical practice at Sanatrix, Rome
References
ESC 2024 — Elevated Blood Pressure and Hypertension
American Heart Association — Home Blood Pressure Monitoring
Read the original Italian guide
Patient information, October 2026. This guide does not replace individual medical assessment.