High blood pressure is a leading risk factor for heart attack, stroke and heart failure.
For years, a blood pressure reading of 140/90 mmHg was considered the threshold for diagnosed hypertension. Still, new guidelines from the European Society of Cardiology are now taking a closer look at even slightly elevated blood pressure levels, a change that could impact preventative care for millions.
The updated recommendations introduce a new category, “elevated blood pressure,” falling between normal ranges and diagnosed hypertension. The goal is to prevent damage to the heart and blood vessels by identifying risk earlier and intervening more proactively. This shift in focus reflects a growing understanding of the importance of early detection and management of cardiovascular risk.
120–139/70–89 mmHg: New Risk Zone Defined
A blood pressure reading below 120/70 mmHg continues to be considered normal. The new “elevated blood pressure” category includes systolic values between 120 and 139 mmHg and diastolic values between 70 and 89 mmHg. In this range, the risk isn’t solely determined by the numbers on the monitor, but by an individual’s overall health profile. The German Hypertension League emphasizes that early and consistent treatment of mildly to moderately elevated blood pressure can prevent long-term cardiovascular complications.
140/90 mmHg: Hypertension Diagnosed
A blood pressure reading of 140/90 mmHg or higher remains the standard for diagnosing arterial hypertension. Treatment is generally recommended at this level to reduce the risk of complications such as heart attack, stroke, kidney damage, or dementia, according to the German Heart Foundation. The European Society of Cardiology recommends a three-step approach: first, assess for pre-existing conditions like heart attack, stroke, or kidney disease; second, calculate an individual’s 10-year cardiovascular risk; and finally, if the situation is unclear, consider additional tests, such as a coronary calcium score or pulse wave velocity measurement.
10-Percent Threshold: When Medication May Be Beneficial
For individuals with readings between 130 and 139 mmHg, the guidelines suggest earlier medication if the calculated cardiovascular 10-year risk is at least ten percent. If this risk is less than five percent, lifestyle changes are usually sufficient. In the intermediate zone of five to ten percent, additional factors such as family history, socioeconomic status, autoimmune diseases, or previous pregnancy complications are considered. Only after considering this comprehensive picture will a decision be made about whether medication is necessary or if close monitoring and non-pharmacological treatment are sufficient.
Target Corridor 120–129 mmHg: How Low Should Blood Pressure Go?
As a general treatment goal, the European Society of Cardiology recommends a systolic blood pressure between 120 and 129 mmHg, provided the patient tolerates this range well. If the upper value is reached, but the lower value cannot be lowered below 80 mmHg, additional therapy may be considered individually. For the very elderly or frail, and for individuals with a limited life expectancy, a more moderate target below 140/90 mmHg may be appropriate. For fit older adults under 85, a target around 120 to 129/80 mmHg is still recommended to protect the heart and blood vessels.
Lifestyle Tips: Less Salt, More Exercise, Targeted Nutrition
Alongside medication, lifestyle remains a key factor in managing blood pressure. The guidelines recommend at least 150 minutes of endurance activity per week and a Mediterranean or DASH-oriented diet. Daily sodium intake should be limited to two grams – equivalent to about five grams of table salt. People with hypertension should limit alcohol consumption to under 100 grams per week, roughly equivalent to one standard drink per day or less. The guidelines similarly emphasize increased potassium intake of 0.5 to one gram per day through potassium-rich foods or potassium-enriched, sodium-reduced salt, provided there is no significant kidney disease. These measures can support blood pressure medication and help delay the need for medication in cases of mildly elevated blood pressure. (This article was created in cooperation with promipool.de)
