Study guide · concept · Intake & vitals
Blood pressure categories for the CCMA: Elevated vs Stage 1
Elevated blood pressure means a systolic of 120–129 with a diastolic under 80. If either number reaches 130–139 or 80–89, the reading is Stage 1, and 140 or 90 on either number makes it Stage 2.
- diastolic needed for Elevated
- < 80
- number can raise the stage
- either
- ACC/AHA categories
- 2017
§01
The categories (2017 ACC/AHA)
Most questions turn on the AND/OR column.
| Category | Systolic (mmHg) | Joined by | Diastolic (mmHg) |
|---|---|---|---|
| Normal | below 120 | AND | below 80 |
| Elevated | 120–129 | AND | below 80 |
| Stage 1 hypertension | 130–139 | OR | 80–89 |
| Stage 2 hypertension | 140 or higher | OR | 90 or higher |
| Hypertensive crisis | above 180 | AND/OR | above 120 |
Hypotension is flagged separately: below 90/60 mmHg in an adult.
§02
Stage any reading in three steps
Two lookups and a comparison. You don't need to memorize readings.
Place the systolic on its own
Below 120 is normal, 120–129 elevated, 130–139 Stage 1, and 140 or higher Stage 2.
Place the diastolic on its own
Below 80 is normal, 80–89 Stage 1, and 90 or higher Stage 2. The diastolic has no “elevated” band.
Take the higher of the two
The reading belongs to whichever number lands in the more severe category. A reading only stays Elevated if the diastolic is under 80.
§03
Worked readings
Cover the last column and stage each one yourself first.
| Reading | Systolic says | Diastolic says | Category |
|---|---|---|---|
| 112/74 | Normal | Normal | Normal |
| 122/78 | Elevated | Normal | Elevated |
| 122/80 | Elevated | Stage 1 | Stage 1 |
| 134/72 | Stage 1 | Normal | Stage 1 |
| 114/86 | Normal | Stage 1 | Stage 1 |
| 142/78 | Stage 2 | Normal | Stage 2 |
| 132/94 | Stage 1 | Stage 2 | Stage 2 |
§04
Check the number before you stage it
If the reading was taken badly, the right rule still gives the wrong answer.
- Patient seated with back supported, feet flat and arm at heart level, after 5 minutes of rest.
- Cuff bladder over the brachial artery, lower edge about 1 inch (2.5 cm) above the antecubital fossa.
- Cuff size matched to the arm. Too small reads falsely high, and too large reads falsely low.
- Deflate at 2–3 mmHg per second. Korotkoff phase I is the systolic, and phase V, when the sounds disappear, is the diastolic.
Technique questions and the other vital-sign ranges (pulse 60–100, respirations 12–20, SpO₂ 95–100%) are on the patient intake and vitals page. Intake and vitals is 14 of the 150 scored items, and staging is one of its most predictable question types.
§05
Three office scenarios
Staging is half the question. The other half is what you do next.
The reading looks high on a large arm
A patient with a large upper arm reads 146/92 on a standard adult cuff. Check the cuff before you stage it, because a cuff that's too small reads high. Retake it with the right size and stage the reading you can trust.
The patient asks whether they have high blood pressure
Record the reading and report it to the provider according to office protocol. Naming a diagnosis is outside the MA's scope even when the numbers are clearly in Stage 2. The scope of practice page covers where that line falls.
The patient feels dizzy on standing
Check orthostatics. The result is positive when the systolic drops by 20 mmHg or the diastolic by 10 on standing, often with the pulse rising by more than 20.
§06
Edge readings
Is 130/80 high blood pressure?
Yes. Under the 2017 ACC/AHA categories it's Stage 1 hypertension: the systolic is in the 130–139 band and the diastolic is in the 80–89 band.
How do Elevated and Stage 1 differ?
Elevated needs both conditions: a systolic of 120–129 and a diastolic below 80. Stage 1 needs only one: a systolic of 130–139 or a diastolic of 80–89.
When should the provider hear about a reading right away?
Above 180 systolic and/or above 120 diastolic is the hypertensive crisis range. Report it to the provider immediately, not at the end of the visit.
§07
Staging questions
7 questions. Pick an answer to see why it is right or wrong.
Run the three steps on every reading, including the ones that look obvious.
Using 2017 ACC/AHA categories, which adult blood pressure reading is Stage 2 hypertension?
Answer & explanation
Answer: C. 136/92 mmHg
Stage 2 is a systolic of 140 or higher OR a diastolic of 90 or higher, so a diastolic of 92 alone qualifies even though the systolic is only 136. 138/88 and 128/84 are Stage 1 (130–139 or 80–89). 139/79 is also Stage 1 because its systolic is 130–139 — the highest number on the list is not automatically the most severe category.
- Systolic 130–139 makes this Stage 1; the low diastolic does not move it into Elevated.
- Diastolic 84 falls in the 80–89 band, so this is Stage 1, not Stage 2.
- Correct: a diastolic of 92 alone meets Stage 2 (≥90), even with systolic only 136.
- Both numbers sit in the Stage 1 bands, 130–139 and 80–89, so it is not Stage 2.
A blood pressure of 138/88 mmHg is classified as:
Answer & explanation
Answer: C. Stage 1 hypertension
A reading of 138/88 is Stage 1 hypertension because the diastolic value is 80–89. It is not Elevated, which requires a diastolic below 80.
- Normal requires both systolic under 120 and diastolic under 80.
- The classic trap: Elevated needs a diastolic under 80, and 88 exceeds that.
- Correct: systolic 130–139 or diastolic 80–89 is Stage 1, and 138/88 meets both.
- Stage 2 starts at 140 systolic or 90 diastolic; neither number reaches it.
A blood pressure of 124/76 mmHg is classified as:
Answer & explanation
Answer: C. Elevated
A systolic of 120–129 with diastolic below 80 is Elevated. Normal requires systolic below 120, so 124 systolic exceeds the normal range.
- Stage 1 starts at 130 systolic or 80 diastolic; 124/76 reaches neither.
- Stage 2 needs 140 systolic or 90 diastolic, well above this reading.
- Correct: systolic 120–129 with diastolic under 80 is Elevated.
- Normal needs a systolic under 120, so 124 is just past it.
Which blood pressure meets the definition of hypotension in an adult?
Answer & explanation
Answer: A. 86/54 mmHg
Hypotension is generally a blood pressure below 90/60 mmHg, so 86/54 qualifies. The other readings are within or above the normal range.
- Correct: hypotension is generally below 90/60 mmHg, and 86/54 is under both numbers.
- 126/80 is far from hypotension; its diastolic of 80 already reaches Stage 1.
- 132/86 sits in the Stage 1 hypertension range, the opposite of hypotension.
- 118/78 is a normal adult reading: systolic under 120 and diastolic under 80.
Using 2017 ACC/AHA categories, how is a blood pressure of 126/82 mmHg classified?
Answer & explanation
Answer: D. Stage 1 hypertension
Stage 1 is a systolic of 130–139 OR a diastolic of 80–89, so a diastolic of 82 places this reading in Stage 1 even though the systolic alone would be 'elevated'. Elevated requires a systolic of 120–129 AND a diastolic below 80. Stage 2 starts at 140 systolic or 90 diastolic.
- Stage 2 needs 140 systolic or 90 diastolic; 126/82 reaches neither.
- The tempting choice: systolic 126 looks Elevated, but Elevated requires a diastolic under 80.
- Normal requires systolic under 120 and diastolic under 80; both are exceeded.
- Correct: a diastolic of 82 falls in the 80–89 band, which is Stage 1 regardless of systolic.
Using 2017 ACC/AHA categories, which adult blood pressure reading is classified as Elevated?
Answer & explanation
Answer: B. 128/78 mmHg
Elevated requires BOTH a systolic of 120–129 AND a diastolic below 80, which only 128/78 meets. A reading of 128/80 is tempting because the systolic matches, but a diastolic of 80 already reaches Stage 1 hypertension.
- Diastolic 80 is in the 80–89 range, so this is Stage 1.
- Correct: systolic 120–129 and diastolic under 80.
- Systolic 130–139 makes this Stage 1 hypertension.
- Under 120 and under 80 is Normal.
An adult's averaged seated blood pressure is 116/84 mmHg. Using 2017 ACC/AHA categories, how is this classified?
Answer & explanation
Answer: D. Stage 1 hypertension
Stage 1 is a systolic of 130–139 OR a diastolic of 80–89, so a diastolic of 84 alone places this reading in Stage 1. It is not Normal, because Normal needs both numbers below their limits (under 120 and under 80). The higher category of either number decides the stage.
- Normal requires the diastolic to be under 80 as well.
- Elevated applies only with systolic 120–129 and diastolic under 80.
- Stage 2 needs a systolic of 140 or more, or a diastolic of 90 or more.
- Correct: the diastolic of 84 alone meets Stage 1.
That is the whole set. Open any card to re-read its explanation, or start over.