Comparison of international blood pressure guidelines
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Guidelines on the choice of agents and how best to step up treatment for various subgroups have changed over time and differ between countries.
Table
| Guideline | Population | Goal BP, mmHg | Initial drug treatment options |
|---|---|---|---|
| JNC8 | General ≥60 y
General <60 y |
<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 ≥80 y 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 <80 y
General ≥80 y Diabetes CKD |
<140/90
<150/90 <130/80 <140/90 |
General: thiazide-type diuretic, beta-blocker (age, 60 y), 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 y
General ≥80 y |
<140/90
<150/90 |
<55 y: ACEI, or ARB
≥55 y 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
- ↑ 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.