Revising blood pressure classification guidelines: A call for normal lower limits in the “American college of cardiology/American heart association task force on clinical practice guidelines for hypertension”

Ersin Akpinar; Ersin Akpinar

ISSN: 2640-771X

Archives of Clinical Hypertension

Letter to Editor Open Access Peer-Reviewed

Revising blood pressure classification guidelines: A call for normal lower limits in the “American college of cardiology/American heart association task force on clinical practice guidelines for hypertension”

Ersin Akpinar*

Author and article information

Cukurova University Faculty of Medicine, Professor of Clinical Family Medicine, Adana, Turkey

*Corresponding author: Ersin Akpinar, Cukurova University Faculty of Medicine, Professor of Clinical Family Medicine, Adana, Turkey, E-mail: akpinar@cu.edu.tr, ersin.akpinar@gmail.com

doi: 10.17352/ach.000033

Received: 20 December, 2023 | Accepted: 29 December, 2023 | Published: 30 December, 2023

Keywords: Blood pressure classification; Lower limits; Guidelines revision; American College of Cardiology/American Heart Association (ACC/AHA) European Society of Cardiology/European Society of Hypertension (ESC/ESH)

Cite this as :

Akpinar E (2023) Revising blood pressure classification guidelines: A call for normal lower limits in the “American college of cardiology/American heart association task force on clinical practice guidelines for hypertension”. Arch Clin Hypertens 9(1): 004-005. DOI: 10.17352/ach.000033

Copyright

© 2023 Akpinar E. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The existing blood pressure classification guidelines established by the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) lack specified lower limits for the “Normal” category. This paper underscores the imperative need for revisiting these guidelines to incorporate defined lower limits for the “Normal” classification. The absence of such lower limits hinders the precision of clinical practice and undermines the comprehensive assessment of blood pressure in individuals. By advocating for the inclusion of lower limits, this paper aims to enhance the accuracy of blood pressure categorization, thereby providing clinicians with more nuanced guidance and fostering improved cardiovascular health outcomes.

Main article text

Introduction

Blood pressure measurement is a fundamental aspect of clinical practice, serving as a critical indicator of cardiovascular health. The American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines have significantly contributed to standardizing blood pressure classification [1,2]. However, these guidelines lack defined lower limits for the “Normal” category, potentially leading to misinterpretation of extremely low blood pressure values. In this paper, we advocate for the inclusion of lower limits within the “Normal” range to enhance the accuracy of blood pressure assessment.

Current blood pressure classification guidelines

The current guidelines, as per the ACC/AHA and ESC/ESH [1-7], categorize blood pressure as follows:

Normal: Less than 120/80 mm Hg;
Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
Stage 1: Systolic between 130-139 or diastolic between 80-89;
Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;

Proposed revision: inclusion of lower limits for normal

We propose revising the guidelines to include defined lower limits for the “Normal” category. This modification will serve several purposes:

Enhanced accuracy: The inclusion of lower limits will provide a clear range within which blood pressure is considered normal. Extremely low values, such as Systolic < 90 mm Hg and Diastolic < 60 mm Hg, should be identified as abnormal and prompt further evaluation.

Akpinar’s proposed revision of hypertension classification including lower limits for normal

NORMAL: Systolic: 90 mm Hg -119 mm Hg

Diastolic: 60 mm Hg - 79 mm Hg

Clinical guidance: A clearer classification will guide healthcare professionals in assessing patients’ blood pressure accurately, minimizing the risk of underdiagnosing or overlooking low blood pressure, which may be indicative of health issues.

Conclusion

In the context of organ perfusion, it is crucial to note that for somatically healthy individuals, a blood pressure range of Systolic: 90 mm Hg - 119 mm Hg and Diastolic: 60 mm Hg - 79 mm Hg is generally considered adequate. However, it is imperative to recognize that in the presence of somatic diseases, the requirements for adequate blood pressure can vary significantly. Moreover, it should be highlighted that the classification of lower blood pressure as ‘normal,’ as per the guidelines of the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH), may not universally align with optimal organ perfusion. Excessively low blood pressure levels, labeled as ‘normal’ in these guidelines, may pose serious risks, including the potential for lethality. Therefore, clinical practitioners should exercise discretion and consider the individual’s health status when interpreting and applying these proposed guidelines, ensuring that blood pressure levels are maintained within a safe and physiologically appropriate range.

The ACC/AHA and ESC/ESH guidelines for blood pressure classification have been instrumental in clinical practice. However, we propose that these guidelines be revised to incorporate lower limits for the “Normal” category. This modification will facilitate more accurate blood pressure assessment, ensuring that extremely low values are not overlooked and that individuals with potentially concerning blood pressure levels receive appropriate attention and care.