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The JNC 7 Blood Pressure Classification System

Classification of Blood Pressure for Adults (>18 years of age)
Blood Pressure Classification
Systolic Blood Pressure
(mm Hg)
Diastolic Blood Pressure
(mm Hg)

Normal

<120

and <80

Prehypertension (Normal)

120–139

or 80–89

Stage 1 Hypertension

140–159

or 90–99

Stage 2 Hypertension

>160

or >100

 

FYI | Why the change in the JNC 7 Classification System?

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“Because of the new data on lifetime risk of hypertension and the impressive increase in the risk of cardiovascular complications associated with levels of BP previously considered to be normal, the JNC 7 report has introduced a new classification that includes the term “prehypertension” for those with BPs ranging from 120–139 mmHg systolic and/or 80–89 mmHg diastolic. This new designation is intended to identify those individuals in whom early intervention by adoption of healthy lifestyles could reduce BP, decrease the rate of progression of BP to hypertensive levels with age, or prevent hypertension entirely. Another change in classification from JNC 6 is the combining of stage 2 and stage 3 hypertension into a single stage 2 category. This revision reflects the fact that the approach to the management of the former two groups is similar.” (JNC 7 Report, 2003)

Classifying your patient’s hypertension

Question 3:

You have brought back your patient, Mary Johnson, for a second appointment to evaluate her blood pressure. From her first visit, she had a blood pressure of 145/80 in both arms taken 2 minutes apart. The rest of her physical exam was negative. Today, you repeat the blood pressures and get 148/ 79 in the left arm and 148/80 in the right arm. How do you diagnose and classify Mary Johnson’s blood pressures? (Choose the one best answer)

  1. Mary Johnson is not hypertensive.
  2. Mary Johnson is prehypertensive.
  3. Mary Johnson is diagnosed with Stage 1 Hypertension.
  4. Mary Johnson is diagnosed with Stagee 2 Hypertension.
  5. Mary Johnson cannot be diagnosed at this second visit.
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The correct answer is C. Mary Johnson has four blood pressure measurements. Two measurements were on the first visit – one on each arm – and both 145/80. She has two more elevated measurements – one on each arm at the second visit. 148/ 79 in the left arm and 148/80 in the right arm. Mary can properly be diagnosed with hypertension. Although her diastolic pressures are in the normal range, her systolic blood pressures are in the Stage 1 range. Therefore you classify her by the worst of the two measurements. She is a Stage 1 essential hypertensive patient.

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