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

A Comparison of International Guidelines on Goal BP and Initial Drug Therapy for Adults With Hypertension (modified from[1])
Guideline Population Goal BP, mmHg Initial drug treatment options
JNC8 General ≥60 y

General <60 y

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 ≥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

  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.