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Biomarker library / Metabolic

Blood pressure (BP)

Also called systolic and diastolic pressure, hypertension numbers

Blood pressure is the force of blood against artery walls, written as two numbers: systolic (pressure while the heart beats) over diastolic (pressure between beats), in millimeters of mercury. The rows below are drawn on the systolic number, with the diastolic criterion in each note. In AHA's 2025 chart, normal and elevated need both numbers to qualify, while stage 1 and stage 2 are met by either one, so a reading takes the higher category its worse number reaches. The severe band is a systolic higher than 180 and/or a diastolic higher than 120. At that level, AHA's chart says to call 911 if you have chest pain, shortness of breath, back pain, numbness, weakness, a change in vision or difficulty speaking, and to call your health care professional if you have none of them.

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mm Hg systolic. Cut points from the sources listed below.

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Population Adults
Category Normal
Range under 120 mm Hg (systolic) And diastolic under 80.
Source American Heart Association release on the 2025 AHA/ACC High Blood Pressure Guideline (categories unchanged from 2017)

Effective

Population Adults
Category Elevated
Range 120 to 129 mm Hg (systolic) With diastolic still under 80.
Source American Heart Association release on the 2025 AHA/ACC High Blood Pressure Guideline (categories unchanged from 2017)

Effective

Population Adults
Category Stage 1 hypertension
Range 130 to 139 mm Hg (systolic) Or diastolic 80 to 89. Confirm with out-of-office readings.
Source American Heart Association release on the 2025 AHA/ACC High Blood Pressure Guideline (categories unchanged from 2017)

Effective

Population Adults
Category Stage 2 hypertension
Range 140 or higher mm Hg (systolic) Or diastolic 90 and above.
Source American Heart Association release on the 2025 AHA/ACC High Blood Pressure Guideline (categories unchanged from 2017)

Effective

Population Adults
Category Severe hypertension (with symptoms: hypertensive emergency, call 911)
Range over 180 mm Hg (systolic) And/or diastolic higher than 120. Without symptoms, call your clinician; with chest pain, shortness of breath, back pain, numbness, weakness, vision change or trouble speaking, call 911.
Source American Heart Association, Blood Pressure Categories chart (WF-950650 7/25), in the gallery of its August 14, 2025 guideline release

Effective

Normal vs optimal

Normal is under 120 systolic AND under 80 diastolic. There is no bonus category below that. Normal is a category, not the treatment goal: for adults with high blood pressure the goal is under 130/80, which ACC's October 2025 summary of the guideline puts as "The overarching BP treatment goal is <130/80 mm Hg for all adults". The AHA's release adds a systolic goal under 130 to protect cognition.

02  /  Why it matters

What the number tells you

High blood pressure is the most consequential number on this site: it drives heart attack, stroke, kidney disease and dementia risk, usually silently. The 2025 AHA/ACC guideline (published August 14, 2025) kept the 2017 categories and pushed earlier treatment; the AHA's release says "The blood pressure criteria remain the same as the 2017 guideline". At 140/90 or higher, the release says treatment starts with two medications at once, preferably in a single pill. Because a single office reading misclassifies many people, a high reading should be confirmed with out-of-office measurement (a home cuff or ambulatory monitor) before a diagnosis; the release recommends home monitoring to confirm a diagnosis made in the office.

03  /  In practice

Testing and what moves it

When it is tested

  • The USPSTF (April 27, 2021): "The USPSTF suggests annual screening for hypertension in adults 40 years or older and for adults at increased risk for hypertension (such as Black persons, persons with high-normal blood pressure, or persons who are overweight or obese). Screening less frequently (ie, every 3 to 5 years) is appropriate for adults aged 18 to 39 years not at increased risk for hypertension and with a prior normal blood pressure reading."
  • Before treatment starts: "The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment."

What raises it

  • Age, weight, high sodium intake, low activity, alcohol, poor sleep and sleep apnea, some medications (NSAIDs, decongestants), stress.

What lowers it

  • Weight loss, the DASH eating pattern, sodium reduction, activity, limiting alcohol, treating sleep apnea; medication when lifestyle is not enough.

04  /  Related

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Frequently asked questions

What is a normal blood pressure by age?

The categories do not change with age: normal is under 120/80 for adults, per the 2025 AHA/ACC guideline. Treatment decisions and targets are individualized in older adults, but the definition of normal is not age-adjusted. Children are read differently. NHLBI: "For children younger than 13, blood pressure readings are compared with readings that are common for children of the same, age, sex, and height."

Which number matters more, the top or the bottom?

Both count, and in AHA's 2025 chart a reading is staged by whichever number is worse. Systolic pressure tends to drive risk after midlife, which is why the rows here are drawn on it, with the diastolic criterion in each note.

My reading at the doctor is always higher than at home. Which is real?

Both are information. Office readings run higher for many people (white-coat effect), which is why the guideline confirms a diagnosis with out-of-office measurement. The AHA's release recommends home monitoring for that confirmation.

One document sets the numbers on this page, published in 2025.

We last re-read these sources on . How we verify.