Blood pressure is a measurement of the force exerted by circulating blood against the walls of the body’s arteries. This measurement is given as two numbers: systolic pressure (SBP), the higher number recorded when the heart beats, and diastolic pressure (DBP), the lower number taken when the heart rests between beats. The European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) provide unified standards to diagnose and manage blood pressure levels and identify individuals at risk for cardiovascular disease.
Defining European Blood Pressure Categories
The ESC/ESH guidelines classify blood pressure into distinct categories based on office measurements. Optimal Blood Pressure, the lowest and most desirable reading, is defined as systolic below 120 mmHg and diastolic below 80 mmHg. Normal Blood Pressure falls within the range of 120–129 mmHg systolic and/or 80–84 mmHg diastolic.
The next classification is High-Normal Blood Pressure, identified by a systolic reading of 130–139 mmHg and/or a diastolic reading of 85–89 mmHg. While not yet considered hypertension, this category indicates an elevated risk that warrants lifestyle intervention and close monitoring. Hypertension itself is then categorized into three grades.
Grade 1 Hypertension begins at a systolic reading of 140–159 mmHg and/or a diastolic reading of 90–99 mmHg. This is the threshold at which a formal diagnosis is made and treatment, often starting with lifestyle changes, is recommended. Progressively higher readings define the more severe grades: Grade 2 Hypertension is 160–179 mmHg systolic and/or 100–109 mmHg diastolic, and Grade 3 Hypertension is any reading of 180 mmHg systolic or higher and/or 110 mmHg diastolic or higher.
Ensuring Accurate Blood Pressure Measurement
Accurate blood pressure measurement is foundational to correctly classifying a patient and guiding treatment. European guidelines emphasize a standardized procedure for taking office blood pressure (OBP) readings. The patient must be seated comfortably in a quiet environment for at least five minutes before measurement, with their arm supported at the heart level.
The devices used should be validated, automated, and use an upper-arm cuff of the correct size to ensure reliable readings. Multiple measurements are required during a single visit: three readings should be recorded, spaced one to two minutes apart, with the last two measurements being averaged to determine the final OBP. If the first two measurements differ by more than 10 mmHg, additional readings are necessary.
European practice recommends using out-of-office blood pressure monitoring to confirm a hypertension diagnosis, especially for high-normal or Grade 1 readings. This includes Ambulatory Blood Pressure Monitoring (ABPM), which takes readings over a 24-hour period, and Home Blood Pressure Monitoring (HBPM). These methods help to identify “white-coat hypertension,” where readings are high only in a clinical setting, or “masked hypertension,” where office readings are normal but out-of-office readings are elevated.
Lifestyle Recommendations for BP Management
Lifestyle modifications are a first-line treatment strategy for individuals with High-Normal blood pressure and Grade 1 Hypertension, supporting management for all other grades. Dietary change focuses on reducing daily salt intake (sodium chloride) to less than 5 grams (under 2 grams of sodium). Increasing consumption of potassium-rich foods, such as fresh fruits and vegetables, is recommended to counteract sodium effects.
Regular physical activity significantly contributes to blood pressure reduction and overall cardiovascular health. This involves engaging in at least 30 minutes of moderate-intensity aerobic exercise, such as brisk walking, on five to seven days per week. The guidelines also recommend maintaining a healthy body weight and waist circumference, as obesity is a factor that increases blood pressure.
Limiting alcohol consumption is another important intervention, with recommendations set at no more than 14 units per week for men and 8 units per week for women, while completely avoiding binge drinking. Beyond diet and exercise, smoking cessation is advised for all patients, as tobacco use significantly elevates blood pressure and overall cardiovascular risk. These non-pharmacological steps are designed to reduce blood pressure and improve health outcomes before or alongside medication.