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Across populations, the risks of heart disease and stroke increase continuously and logarithmically with increasing levels of systolic and diastolic blood pressure at or above 115/75 mm Hg ( Fig. 66-1 ).

Thus, the dichotomous separation of “normal” from “high” blood pressure is artificial, and the definition of arterial hypertension (i.e., high blood pressure) has been a moving target.

On the basis of results of randomized clinical drug trials, hypertension currently is defined as a usual blood pressure of 140/90 mm Hg or higher ( Table 66-1 ), the value above which the benefits of treatment appear to outweigh the risks.

Prehypertension is a new designation for mildly elevated blood pressures between 120/80 and 139/89 mm Hg, a level at which progression to hypertension is twice as likely as with a blood pressure below 120/80 mm Hg, and cardiovascular risk retains its continuous log-linear function compared with lower blood pressures.

The cardiovascular mortality rate is only half as great at 120/80 mm Hg as at 140/90 mm Hg, but it is unknown whether the benefits of treating prehypertension outweigh the risks.