Cardiovascular Risk

Arterial hypertension is a major cardiovascular risk factor: the higher the blood pressure values, the greater the risk.
Additionally, since hypertension is often associated with other diseases and risk factors, proper risk stratification must consider the number and type of additional risk factors.

Repetita iuvant: Arterial hypertension is defined as:

• 
  Persistently elevated blood pressure values above 140 mmHg systolic and/or above 90 mmHg diastolic
  
  

Based on the severity of blood pressure elevation, different grades of hypertension are distinguished, each associated with an increasing cardiovascular risk:

	Systolic Pressure (mmHg)	Diastolic Pressure (mmHg)
Optimal Pressure	<120	<80
Normal Pressure	120-129	80-84
High-Normal Pressure	130-139	85-89
Hypertension Grade 1	140-159	90-99
Hypertension Grade 2	160-179	100-109
Hypertension Grade 3	≥180	≥110

Both normal and high-normal blood pressure values are considered physiological. A diagnosis of arterial hypertension is made when blood pressure values persistently exceed 140 mmHg systolic and 90 mmHg diastolic.
High-normal blood pressure is considered borderline and also called prehypertension. Individuals with high-normal blood pressure are not hypertensive but have a higher likelihood of developing hypertension over time.
For a comprehensive assessment of cardiovascular risk, it is essential to consider additional risk factors such as family history, obesity, dyslipidemia, diabetes, atherosclerosis, and other comorbidities affecting vascular health.
Hypertension is often found in a broader context known as Metabolic Syndrome. Furthermore, its incidence increases with age, and elderly patients are often frail, with a precarious homeostatic balance, multiple comorbidities, and polypharmacy.

Based on blood pressure levels and the presence or absence of other cardiovascular risk factors, different levels of cardiovascular risk are distinguished:

Other Risk Factors	Normal Pressure	High-Normal Pressure	Mild Hypertension	Moderate Hypertension	Severe Hypertension
None	No Additional Risk	No Additional Risk	Low Risk	Moderate Risk	High Risk
Up to 2 without diabetes	Low Risk	Low Risk	Moderate Risk	Moderate Risk	Very High Risk
More than 2 or with diabetes	Moderate Risk	High Risk	High Risk	High Risk	Very High Risk
Cardiovascular or Renal Disease	Very High Risk	Very High Risk	Very High Risk	Very High Risk	Very High Risk
Cardiovascular risk refers to the increased probability of cardiovascular events within 10 years. Low Risk 15% or less Moderate Risk 15-20% High Risk 20-30% Very High Risk > 30%

References
1. Whelton PK, et al. 2017 ACC/AHA Hypertension Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248.
2. Williams B, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104.
3. Unger T, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. J Hypertens. 2020;38(6):982-1004.
4. Chrysafinos M, et al. New Insights into Cardiovascular Risk Stratification in Hypertension. Hypertension. 2021;77(4):1203-1214.
5. James PA, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA. 2014;311(5):507-520.
6. Carretero OA, Oparil S. Essential hypertension. Part I: Definition and etiology. Circulation. 2000;101(3):329-335.
7. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 Suppl):S484-S492.