Comparison of international blood pressure guidelines

Guidelines on the choice of agents and how best to step up treatment for various subgroups have changed over time and differ between countries (see Table - A Comparison of International Guidelines on Goal BP and Initial Drug Therapy for Adults With Hypertension).

A Comparison of International

Guidelines on Goal BP and

Initial Drug Therapy for Adults With Hypertension

(modified from[1])

Population Goal BP, mmHg Initial drug treatment options
JNC8 General ≥ 60y

General < 60y

Diabetes

CKD

<150/90

<140/90

<140/90

<140/90

Non-black: thiazide-type diuretic, ACEI, ARB, or CCB

Black: thiazide-type diuretic, or CCB

Diabetes: thiazide-type diuretic, ACEI, ARB, or CCB

CKD: ACEI or ARB

ESH/ESC 2008 General nonelderly

General elderly

General ≥ 80y

Diabetes

CKD

CKD + proteinuria

<140/90

<150/90

<150/90

<140/85

<140/90

<130/90

General: beta-blocker, diuretic, CCB, ACEI, or ARB

Diabetes: ACEI, or ARB

CKD: ACEI, or ARB

CHEP 2013 General < 80y

General ≥ 80y

Diabetes

CKD

<140/90

<150/90

<130/80

<140/90

General: thiazide-type diuretic, beta-blocker (age,60y) ACEI (non-black) or ARB

Diabetes with additional risk : ACEI, or ARB

Diabetes without additional risk : ACEI, ARB, thiazide, or DHPCCB

CKD: ACEI, or ARB

ADA 2013 Diabetes <140/90 ACEI, or ARB
KDIGO CKD no proteinuria

CKD + proteinuria

≤140/90

≤130/80

ACEI, or ARB
NICE 2011 General <80

General ≥80

<140/90

<150/90

<55y: ACEI, or ARB

≥55y or black: CCB

ISHIB Black, lower risk

Target organ damage or CVD risk

<135/85

<130/80

Diuretic or CCB
Abbreviations
ADA, American Diabetes Association; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor; CCB, calcium channel blocker; CHEP, Canadian Hypertension Education Program; CKD, chronic kidney disease; CVD, cardiovascular disease; DHPCCB, dihydropyridine calcium channel blocker; ESC, European Society of Cardiology; ESH, European Society of Hypertension; ISHIB, International Society for Hypertension in Blacks; JNC, Joint National Committee; KDIGO, Kidney Disease: Improving Global Outcome; NICE, National Institute for Health and Clinical Excellence

References

  1. James, PA.; Oparil, S.; Carter, BL.; Cushman, WC.; Dennison-Himmelfarb, C.; Handler, J.; Lackland, DT.; Lefevre, ML.; Mackenzie, TD.; Ogedegbe, Olugbenga; Smith, Sidney C.; Svetkey, Laura P.; Taler, Sandra J.; Townsend, Raymond R.; Wright, Jackson T.; Narva, Andrew S.; Ortiz, Eduardo (Dec 2013). "2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.
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