A blood pressure reading below 120/80 is considered normal, 120–129 over less than 80 is elevated, and 130/80 or higher counts as high blood pressure under the 2025 American College of Cardiology and American Heart Association guideline. These categories are the same for adults of every age, including people over 60, but the right personal target for you is something to set with your doctor.
Key takeaways
- The 2025 guideline kept the same five categories used since 2017: normal, elevated, stage 1, stage 2 and severe.
- A reading lands in the higher category if either number is high. For example, 128/84 counts as stage 1 because the bottom number is in the 80–89 range.
- The guideline says most adults should be treated to below 130/80, and it encourages a top number below 120 if that can be reached without side effects.
- Home readings help confirm what is happening outside the doctor's office, but only if you measure the right way.
- A reading higher than 180/120 with symptoms such as chest pain, numbness or trouble speaking means call 911.
What the two numbers mean
Every blood pressure reading has two numbers, written like a fraction, such as 124/76. Both are measured in millimeters of mercury, often shortened to mm Hg.
The top number (systolic) is the pressure in your arteries when your heart beats and pushes blood out. The bottom number (diastolic) is the pressure in your arteries while your heart rests between beats.
Both numbers matter. Many people notice that their top number creeps up as the years go by, while the bottom number stays about the same or even drops. That is why older adults often see readings like 142/74, where only the top number is out of range. Under the guideline, that reading still counts as stage 2 high blood pressure.
Blood pressure chart: the 2025 categories
The table below shows the categories from the 2025 ACC/AHA High Blood Pressure Guideline. Notice the words "and" and "or" in the middle column. They decide which row your reading falls into.
| Category | Top number (systolic) | Bottom number (diastolic) | |
|---|---|---|---|
| Normal | Less than 120 | and | Less than 80 |
| Elevated | 120–129 | and | Less than 80 |
| Stage 1 high blood pressure | 130–139 | or | 80–89 |
| Stage 2 high blood pressure | 140 or higher | or | 90 or higher |
| Severe (crisis) | Higher than 180 | and/or | Higher than 120 |
To be "normal" or "elevated," both numbers have to fit the row. For stage 1 or stage 2, only one number needs to reach that range. When your two numbers point to different rows, use the higher category.
Enter your latest reading and see which category it falls into in a few seconds.
Check your blood pressure readingWorked examples: reading the chart
Here is how the "and/or" rule works with a few sample readings. These are made-up numbers to show the method, not real patients.
Example 1: 118/76
The top number is less than 120 and the bottom number is less than 80. Both fit the first row, so this reading is normal.
Example 2: 126/78
The top number, 126, is in the 120–129 range. The bottom number, 78, is less than 80. Both fit the elevated row, so this reading is elevated.
Example 3: 128/84
The top number alone would be elevated. But the bottom number, 84, is in the 80–89 range, and stage 1 only needs one number to qualify. The higher category wins, so this reading is stage 1.
Example 4: 146/72
The bottom number is normal, but the top number is 140 or higher. That is enough for stage 2. This pattern, a high top number with a normal or low bottom number, is common in older adults.
Example 5: averaging two readings
Say you take two readings one minute apart and get 134/82 and 130/78. Add the top numbers and divide by two: 134 + 130 = 264, and 264 ÷ 2 = 132. Do the same for the bottom numbers: 82 + 78 = 160, and 160 ÷ 2 = 80. The average is 132/80, which falls in stage 1. Writing down both readings, and the average, gives your doctor a clearer picture than a single number.
What changed in the 2025 guideline, and what did not
The categories themselves did not change. A reading that was stage 1 under the 2017 guideline is still stage 1 today. What the 2025 guideline added is more detail on treatment goals and risk.
- Treatment goal: it says most adults should be treated to below 130/80, and it encourages a top number below 120 when that can be reached without side effects.
- Risk estimate: it uses a tool called the PREVENT calculator to estimate a person's 10-year risk of heart disease and stroke. Your doctor may use this when deciding on next steps.
- Home and out-of-office readings: it supports home monitoring and ambulatory monitoring (a device worn for a day or so) to confirm readings. This helps catch "white-coat hypertension," where readings are high only at the office, and "masked hypertension," where readings look fine at the office but are high at home.
For older adults, targets are personal. Your doctor will weigh your other health conditions, your medicines and how you feel. If you have questions about any medicine you take for blood pressure, talk with your doctor or pharmacist rather than changing anything on your own. Our guide to managing multiple medications has tips for keeping track of everything you take.
How to measure your blood pressure at home
A home reading is only useful if it is taken the same careful way each time. Small things, like a cup of coffee or crossed legs, can push the numbers up.
- Avoid caffeine, exercise and smoking for 30 minutes before you measure.
- Sit quietly for 5 minutes with your back supported and your feet flat on the floor.
- Rest your arm on a table so the cuff is at heart level.
- Use a cuff that is the correct size for your arm. A cuff that is too small can give a falsely high reading.
- Take 2 readings, 1 minute apart, and write both down with the date and time.
Bring your log to your appointments. Blood pressure is also checked at the Medicare Annual Wellness Visit, which is a good moment to compare your home numbers with the office reading.
Everyday habits that support healthy blood pressure
Blood pressure is shaped by many things, and some of them are within your control. Regular physical activity is one of the most helpful. The CDC recommends at least 150 minutes a week of moderate activity for adults 65 and older, such as a brisk 30-minute walk on 5 days. Our exercise guidelines for older adults explain how to build up safely, and the target heart rate calculator can help you judge your effort.
Good sleep, a balanced diet and keeping a healthy weight also play a part. If you are unsure where your weight stands, the BMI calculator is a simple starting point, though it has limits for older adults. Always discuss big changes in your routine with your doctor, especially if you have heart or kidney problems.
When to call your doctor or 911
A single high reading is not a reason to panic. Readings change through the day. But some situations need quick action.
- Reading higher than 180 on top or 120 on the bottom, with no symptoms: wait a few minutes and measure again. If it is still that high, contact your doctor right away.
- Reading that high with symptoms: if you have chest pain, shortness of breath, back pain, numbness or weakness, a change in vision or trouble speaking, call 911. Do not wait to see if it goes away.
- Readings that stay in stage 1 or stage 2 over several days: share your log with your doctor at your next visit, or sooner if they have asked you to.
Numbness, weakness or trouble speaking can also be signs of a stroke. Learn the full list in our guide to stroke and heart attack warning signs.
Frequently asked questions
Is high blood pressure normal for people over 65?
It is common, but the categories are the same at every adult age. A top number of 140 or higher counts as stage 2 whether you are 45 or 85. Your doctor will set a personal target based on your overall health.
What if only my top number is high?
Only one number needs to be in range for stage 1 or stage 2. A reading of 144/70, for example, counts as stage 2 because the top number is 140 or higher. Share readings like this with your doctor.
Did the 2025 guideline change the blood pressure chart?
No. The five categories are the same as in 2017. The 2025 guideline added guidance on treatment goals, the PREVENT risk calculator and the value of home and ambulatory readings.
Why is my reading higher at the doctor's office than at home?
Some people have higher readings in a medical setting, known as white-coat hypertension. Careful home readings, taken the same way each time, help your doctor see the full picture.
How often should I check my blood pressure at home?
Ask your doctor what schedule suits you. Whenever you measure, take 2 readings 1 minute apart, write them down and bring the log to your appointments.
Sources
This guide is general health information for education. It is not medical advice and does not replace a visit with your doctor or pharmacist. Never start, stop or change a medicine without talking to them. In an emergency call 911. Spotted an error? Let us know.