{
 "$schema": "https://tonelva.com/api/v1/openapi.json",
 "id": "reference-tables",
 "title": "Blood pressure classification tables",
 "description": "The 2017 ACC/AHA categories and the 2018 ESC/ESH office categories as data, plus the derived formulas and the home-monitoring averaging protocol. Bands are ordered most severe first and the first match wins: a reading whose two numbers fall in different bands takes the higher one, under both guidelines.",
 "url": "https://tonelva.com/api/v1/reference-tables.json",
 "documentation": "https://tonelva.com/api/",
 "generated": "2026-09-17T06:58:39.857Z",
 "publisher": {
  "name": "Tonelva",
  "legal_name": "Vast Flow, LLP",
  "url": "https://tonelva.com/",
  "documentation": "https://tonelva.com/api/",
  "contact": "support@tonelva.com",
  "about": "https://tonelva.com/about/",
  "note": "Tonelva publishes reference material and free calculators, and builds a blood pressure diary app. It is not a clinical body and sets no thresholds of its own: every category here is quoted from a published guideline and cited to the society that issued it."
 },
 "licence": {
  "id": "CC-BY-4.0",
  "name": "Creative Commons Attribution 4.0 International",
  "url": "https://creativecommons.org/licenses/by/4.0/",
  "attribution": "Tonelva (https://tonelva.com)",
  "covers": "The compilation: the machine-readable encoding of the two classification tables, the derived formulas, the tool catalogue and every field of this API. Use it commercially, modify it, redistribute it; credit Tonelva with a link.",
  "does_not_cover": "The guidelines themselves. The thresholds are quoted from the documents cited on each table; the societies that published them hold their own rights in those documents."
 },
 "upstream_sources": [
  {
   "id": "aha-2017",
   "name": "2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults",
   "publisher": "American College of Cardiology / American Heart Association",
   "doi": "10.1161/HYP.0000000000000065",
   "url": "https://doi.org/10.1161/HYP.0000000000000065",
   "asOf": "2017-11-13"
  },
  {
   "id": "esc-esh-2018",
   "name": "2018 ESC/ESH Guidelines for the management of arterial hypertension",
   "publisher": "European Society of Cardiology / European Society of Hypertension",
   "doi": "10.1093/eurheartj/ehy339",
   "url": "https://doi.org/10.1093/eurheartj/ehy339",
   "citation": "European Heart Journal 39(33), 3021–3104, 25 August 2018.",
   "asOf": "2018-08-25",
   "superseded_in_part_by": "2024 ESC Guidelines for the management of elevated blood pressure and hypertension"
  },
  {
   "id": "home-monitoring-protocol",
   "name": "Home blood pressure monitoring protocol: seven consecutive mornings and evenings, duplicate readings, first day discarded",
   "publisher": "Common to the ACC/AHA, ESC/ESH and ESH home-monitoring guidance",
   "url": "https://tonelva.com/vitals/home-blood-pressure-monitoring/",
   "asOf": "2018-08-25"
  }
 ],
 "scope_limits": {
  "no_diagnosis": "A category is a label for one measurement, not a diagnosis. Hypertension is diagnosed from repeated readings, usually taken away from a clinic, interpreted by a doctor.",
  "no_treatment": "Nothing here recommends, starts, stops or adjusts medication, and no target figure here is a personal target. Targets are set by the clinician managing that person's care.",
  "no_measurement": "Tonelva records readings from a cuff. Neither the app nor a phone measures blood pressure, and any product claiming to do so from a camera or a fingertip is not measuring it either.",
  "emergency": "A reading above 180 systolic or 120 diastolic together with chest pain, breathlessness, weakness, vision change or confusion is emergency care, not a diary entry.",
  "two_frameworks": "Every classification returns BOTH the 2017 ACC/AHA and the 2018 ESC/ESH category. Reporting one without the other is how a reader ends up with two reputable sources that contradict each other and no way to reconcile them."
 },
 "not_published": [
  {
   "what": "The competitor app snapshot behind /compare/ — ratings, prices, release dates and store descriptions.",
   "why": "That metadata comes from the Apple App Store and is Apple's to license, not ours, and the descriptions are each publisher's own marketing. Republishing either keyless and CC BY would relicense content we do not own and distribute our competitors' copy at our cost.",
   "instead": "https://tonelva.com/compare/"
  },
  {
   "what": "Any blood pressure reading entered by anyone, in the app or in a calculator on this site.",
   "why": "There is nothing to publish. The calculators run entirely in the browser and transmit nothing; the app keeps its diary on the device. No reading reaches a server that could publish it, and publishing one is not something a user agreed to.",
   "instead": "https://tonelva.com/privacy/"
  },
  {
   "what": "Population statistics on blood pressure — prevalence, distribution by age, outcome rates.",
   "why": "Tonelva measures nothing and holds no cohort. Quoting such figures from a dataset we did not build would put our name on numbers we cannot stand behind.",
   "instead": "https://www.who.int/data/gho"
  }
 ],
 "count": 13,
 "engine": {
  "url": "https://tonelva.com/js/engine.js",
  "version": "1.0.0",
  "note": "The ES module the browser calculators, these endpoints and the MCP tools all import. One copy of the arithmetic, so there is nothing left to disagree."
 },
 "reading_limits": {
  "systolic": {
   "min": 50,
   "max": 300
  },
  "diastolic": {
   "min": 30,
   "max": 200
  },
  "rule": "Systolic must be greater than diastolic."
 },
 "how_to_classify": [
  "Take the bands in the order given. The first whose systolic OR diastolic condition is met is the category.",
  "A reading is never lowered by its other number: 118/92 is stage 2 under ACC/AHA and grade 1 under ESC/ESH on the diastolic alone.",
  "Report BOTH tables. Reporting one leaves a reader with two reputable sources that contradict each other and no way to reconcile them.",
  "The `low` band in each table is Tonelva's own overlay, flagged with `published_band: false`. Neither guideline publishes a hypotension band in its office classification; do not cite it to one."
 ],
 "europe_changed_in_2024": {
  "document": "2024 ESC Guidelines for the management of elevated blood pressure and hypertension",
  "doi": "10.1093/eurheartj/ehae178",
  "url": "https://doi.org/10.1093/eurheartj/ehae178",
  "published": "2024-08-30",
  "changed": "Replaced the optimal / normal / high-normal ladder below 140/90 with one category, \"elevated blood pressure\", covering 120–139 systolic or 70–89 diastolic.",
  "unchanged": "Office hypertension remains 140/90 mmHg or higher.",
  "previous": "The 2018 ESC/ESH table — retained by the 2023 ESH guideline and used by the categories in this dataset — splits that range into normal (120–129 / 80–84) and high-normal (130–139 / 85–89).",
  "why_the_older_table_is_used_here": "It is the table printed on home monitors, in patient leaflets and in most published charts, and it is the one that lines up row for row against the ACC/AHA categories a reader is trying to reconcile. The difference is explained at https://tonelva.com/vitals/aha-vs-esc-blood-pressure-guidelines/",
  "explainer": "https://tonelva.com/vitals/aha-vs-esc-blood-pressure-guidelines/"
 },
 "derived_formulas": [
  {
   "id": "mean-arterial-pressure",
   "name": "Mean arterial pressure",
   "formula": "MAP = diastolic + (systolic − diastolic) ÷ 3",
   "equivalent": "MAP = (systolic + 2 × diastolic) ÷ 3",
   "why": "Diastole is weighted twice because the heart spends roughly two-thirds of each cycle in diastole at a resting rate.",
   "usual_range_mmHg": [
    70,
    100
   ],
   "perfusion_floor_mmHg": 65,
   "caveat": "A resting-conditions estimate from cuff numbers, not a third pressure the monitor measured. Primarily an inpatient variable; home diaries are read on the systolic and diastolic numbers. The 70–100 range is a population figure, not a target.",
   "tool": "https://tonelva.com/tools/mean-arterial-pressure-calculator/"
  },
  {
   "id": "pulse-pressure",
   "name": "Pulse pressure",
   "formula": "PP = systolic − diastolic",
   "bands": {
    "narrow": "<25 mmHg",
    "usual": "25–60 mmHg",
    "wide": ">60 mmHg"
   },
   "caveat": "Widens as the large arteries stiffen, so it climbs with age. A population-level risk marker, never a personal prognosis, and one value from one reading says very little.",
   "tool": "https://tonelva.com/tools/pulse-pressure-calculator/"
  }
 ],
 "averaging_protocol": {
  "days": 7,
  "per_day": "One morning and one evening reading (each ideally the mean of two taken a minute apart on the same cuff).",
  "discard_first_day": true,
  "why_discard": "First-day readings run high — unfamiliarity with the cuff, and the reading that prompted the week of measuring in the first place. Every home-monitoring protocol discards day one, and it is the step almost everyone misses.",
  "minimum_useful_readings": 12,
  "source": {
   "id": "home-monitoring-protocol",
   "name": "Home blood pressure monitoring protocol: seven consecutive mornings and evenings, duplicate readings, first day discarded",
   "publisher": "Common to the ACC/AHA, ESC/ESH and ESH home-monitoring guidance",
   "url": "https://tonelva.com/vitals/home-blood-pressure-monitoring/",
   "asOf": "2018-08-25"
  }
 },
 "sources": [
  {
   "id": "aha-2017",
   "name": "2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults",
   "publisher": "American College of Cardiology / American Heart Association",
   "doi": "10.1161/HYP.0000000000000065",
   "url": "https://doi.org/10.1161/HYP.0000000000000065",
   "asOf": "2017-11-13"
  },
  {
   "id": "esc-esh-2018",
   "name": "2018 ESC/ESH Guidelines for the management of arterial hypertension",
   "publisher": "European Society of Cardiology / European Society of Hypertension",
   "doi": "10.1093/eurheartj/ehy339",
   "url": "https://doi.org/10.1093/eurheartj/ehy339",
   "citation": "European Heart Journal 39(33), 3021–3104, 25 August 2018.",
   "asOf": "2018-08-25",
   "superseded_in_part_by": "2024 ESC Guidelines for the management of elevated blood pressure and hypertension"
  },
  {
   "id": "home-monitoring-protocol",
   "name": "Home blood pressure monitoring protocol: seven consecutive mornings and evenings, duplicate readings, first day discarded",
   "publisher": "Common to the ACC/AHA, ESC/ESH and ESH home-monitoring guidance",
   "url": "https://tonelva.com/vitals/home-blood-pressure-monitoring/",
   "asOf": "2018-08-25"
  }
 ],
 "data": {
  "acc-aha-2017": {
   "name": "2017 ACC/AHA categories",
   "used_in": "United States",
   "hypertension_threshold": "130/80 mmHg",
   "source": {
    "id": "aha-2017",
    "name": "2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults",
    "publisher": "American College of Cardiology / American Heart Association",
    "doi": "10.1161/HYP.0000000000000065",
    "url": "https://doi.org/10.1161/HYP.0000000000000065",
    "asOf": "2017-11-13"
   },
   "bands": [
    {
     "id": "crisis",
     "name": "Hypertensive crisis",
     "rank": 5,
     "systolic": ">180",
     "diastolic": ">120",
     "combine": "or",
     "published_band": true,
     "note": "Above the crisis threshold. With chest pain, breathlessness, weakness, vision change or confusion this is emergency care, not a diary entry."
    },
    {
     "id": "stage2",
     "name": "Stage 2 hypertension",
     "rank": 4,
     "systolic": "≥140",
     "diastolic": "≥90",
     "combine": "or",
     "published_band": true,
     "note": "At or above 140 systolic or 90 diastolic under the American thresholds."
    },
    {
     "id": "stage1",
     "name": "Stage 1 hypertension",
     "rank": 3,
     "systolic": "130–139",
     "diastolic": "80–89",
     "combine": "or",
     "published_band": true,
     "note": "The 2017 guideline moved this boundary down from 140/90, which is why this reading is labelled differently in Europe."
    },
    {
     "id": "elevated",
     "name": "Elevated",
     "rank": 2,
     "systolic": "120–129",
     "diastolic": "<80",
     "combine": "and",
     "published_band": true,
     "note": "Systolic between 120 and 129 with diastolic under 80."
    },
    {
     "id": "low",
     "name": "Low",
     "rank": 1,
     "systolic": "<90",
     "diastolic": "<60",
     "combine": "or",
     "published_band": false,
     "note": "Below the usual range. Low readings matter mainly when they come with symptoms."
    },
    {
     "id": "normal",
     "name": "Normal",
     "rank": 0,
     "systolic": "<120",
     "diastolic": "<80",
     "combine": "and",
     "published_band": true,
     "note": "Under 120 systolic and under 80 diastolic."
    }
   ]
  },
  "esc-esh-2018": {
   "name": "2018 ESC/ESH office categories",
   "used_in": "Europe; retained by the 2023 ESH guideline",
   "hypertension_threshold": "140/90 mmHg",
   "source": {
    "id": "esc-esh-2018",
    "name": "2018 ESC/ESH Guidelines for the management of arterial hypertension",
    "publisher": "European Society of Cardiology / European Society of Hypertension",
    "doi": "10.1093/eurheartj/ehy339",
    "url": "https://doi.org/10.1093/eurheartj/ehy339",
    "citation": "European Heart Journal 39(33), 3021–3104, 25 August 2018.",
    "asOf": "2018-08-25",
    "superseded_in_part_by": "2024 ESC Guidelines for the management of elevated blood pressure and hypertension"
   },
   "superseded_in_part": {
    "document": "2024 ESC Guidelines for the management of elevated blood pressure and hypertension",
    "doi": "10.1093/eurheartj/ehae178",
    "url": "https://doi.org/10.1093/eurheartj/ehae178",
    "published": "2024-08-30",
    "changed": "Replaced the optimal / normal / high-normal ladder below 140/90 with one category, \"elevated blood pressure\", covering 120–139 systolic or 70–89 diastolic.",
    "unchanged": "Office hypertension remains 140/90 mmHg or higher.",
    "previous": "The 2018 ESC/ESH table — retained by the 2023 ESH guideline and used by the categories in this dataset — splits that range into normal (120–129 / 80–84) and high-normal (130–139 / 85–89).",
    "why_the_older_table_is_used_here": "It is the table printed on home monitors, in patient leaflets and in most published charts, and it is the one that lines up row for row against the ACC/AHA categories a reader is trying to reconcile. The difference is explained at https://tonelva.com/vitals/aha-vs-esc-blood-pressure-guidelines/",
    "explainer": "https://tonelva.com/vitals/aha-vs-esc-blood-pressure-guidelines/"
   },
   "bands": [
    {
     "id": "grade3",
     "name": "Grade 3 hypertension",
     "rank": 5,
     "systolic": "≥180",
     "diastolic": "≥110",
     "combine": "or",
     "published_band": true,
     "note": "Severe range under the European classification."
    },
    {
     "id": "grade2",
     "name": "Grade 2 hypertension",
     "rank": 4,
     "systolic": "160–179",
     "diastolic": "100–109",
     "combine": "or",
     "published_band": true,
     "note": "Moderate range under the European classification."
    },
    {
     "id": "grade1",
     "name": "Grade 1 hypertension",
     "rank": 3,
     "systolic": "140–159",
     "diastolic": "90–99",
     "combine": "or",
     "published_band": true,
     "note": "Europe kept the diagnostic threshold at 140/90."
    },
    {
     "id": "high-normal",
     "name": "High-normal",
     "rank": 2,
     "systolic": "130–139",
     "diastolic": "85–89",
     "combine": "or",
     "published_band": true,
     "note": "A band the American system does not have — it is where the two guidelines visibly part company."
    },
    {
     "id": "normal",
     "name": "Normal",
     "rank": 1,
     "systolic": "120–129",
     "diastolic": "80–84",
     "combine": "or",
     "published_band": true,
     "note": "120 to 129 systolic or 80 to 84 diastolic."
    },
    {
     "id": "low",
     "name": "Low",
     "rank": 0,
     "systolic": "<90",
     "diastolic": "<60",
     "combine": "or",
     "published_band": false,
     "note": "Below the usual range."
    },
    {
     "id": "optimal",
     "name": "Optimal",
     "rank": 0,
     "systolic": "<120",
     "diastolic": "<80",
     "combine": "and",
     "published_band": true,
     "note": "Under 120 systolic and under 80 diastolic."
    }
   ]
  }
 }
}