Comparison of international blood pressure guidelines: Difference between revisions

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<135/85
<135/85
|Stage 1 >140/90 and low-risk for ASCVD: Lifestyle changes
|BP >140/90 and low-risk for ASCVD: Lifestyle changes


Stage 1 >140/90 and ASCVD risk factors or failed lifestyle changes: monotherapy with thiazide-type diuretic, ACEI, ARB, or CCB
BP >140/90 and ASCVD risk factors or failed lifestyle changes: monotherapy with thiazide-type diuretic, ACEI, ARB, or CCB


Stage 2 > 160/100: two from different classes - thiazide-type diuretic, ACEI, ARB, or CCB
BP >160/100: two from different classes - thiazide-type diuretic, ACEI, ARB, or CCB
|-
|-
| {{Tooltip|KDIGO|Kidney Disease: Improving Global Outcome}} 2021<ref>{{Cite journal |last=Cheung |first=Alfred K. |last2=Chang |first2=Tara I. |last3=Cushman |first3=William C. |last4=Furth |first4=Susan L. |last5=Hou |first5=Fan Fan |last6=Ix |first6=Joachim H. |last7=Knoll |first7=Gregory A. |last8=Muntner |first8=Paul |last9=Pecoits-Filho |first9=Roberto |last10=Sarnak |first10=Mark J. |last11=Tobe |first11=Sheldon W. |last12=Tomson |first12=Charles R.V. |last13=Mann |first13=Johannes F.E. |date=2021-03 |title=KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease |url=https://linkinghub.elsevier.com/retrieve/pii/S0085253820312709 |journal=Kidney International |language=en |volume=99 |issue=3 |pages=S1–S87 |doi=10.1016/j.kint.2020.11.003}}</ref>
| {{Tooltip|KDIGO|Kidney Disease: Improving Global Outcome}} 2021<ref>{{Cite journal |last=Cheung |first=Alfred K. |last2=Chang |first2=Tara I. |last3=Cushman |first3=William C. |last4=Furth |first4=Susan L. |last5=Hou |first5=Fan Fan |last6=Ix |first6=Joachim H. |last7=Knoll |first7=Gregory A. |last8=Muntner |first8=Paul |last9=Pecoits-Filho |first9=Roberto |last10=Sarnak |first10=Mark J. |last11=Tobe |first11=Sheldon W. |last12=Tomson |first12=Charles R.V. |last13=Mann |first13=Johannes F.E. |date=2021-03 |title=KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease |url=https://linkinghub.elsevier.com/retrieve/pii/S0085253820312709 |journal=Kidney International |language=en |volume=99 |issue=3 |pages=S1–S87 |doi=10.1016/j.kint.2020.11.003}}</ref>

Revision as of 22:55, 24 March 2024

Guidelines on the choice of agents and how best to step up treatment for various subgroups have changed over time and differ between countries.

A Comparison of International Guidelines on Goal BP and Initial Drug Therapy for Adults With Hypertension (adapted from JNC 8 guidelines[1])
Guideline Population Goal BP, mmHg Initial drug treatment options
AAFP 2022[2][3] General - Strong Recommendation

General - Weak Recommendation

<140/90


<135/85

BP >140/90 and low-risk for ASCVD: Lifestyle changes

BP >140/90 and ASCVD risk factors or failed lifestyle changes: monotherapy with thiazide-type diuretic, ACEI, ARB, or CCB

BP >160/100: two from different classes - thiazide-type diuretic, ACEI, ARB, or CCB

KDIGO 2021[4] CKD

with kidney transplant

SBP <120

<130/80

CKD: ACEI or ARB

Kidney transplant: ARB or CCB

NICE 2019[5] General <80 y

General ≥80 y

<140/90

<150/90

<55 y: ACEI, or ARB

≥55 y or black: CCB

ACC/AHA 2017[6] General <130/80 BP > 130/80: Lifestyle changes and monotherapy with thiazide-type diuretic, ACEI, ARB, or CCB

BP >20//10 above target: Lifestyle changes and two from different classes - thiazide-type diuretic, ACEI, ARB, or CCB

JNC 8 2013[1] 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
ISHIB Black, lower risk

Target organ damage or CVD risk

<135/85

<130/80

Diuretic or CCB

Abbreviations:

  • AAFP – American Academy of Family Physicians
  • ACC – American College of Cardiology
  • ACEI – angiotensin-converting enzyme inhibitor
  • ADA – American Diabetes Association
  • AHA – American Heart Association
  • ARB – angiotensin receptor blocker
  • 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 (United Kingdom)


References

  1. ^ a b 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.
  2. ^ Coles, Sarah; Fisher, Lynn; Lin, Kenneth W.; Lyon, Corey; Vosooney, Alexis A.; Bird, Melanie D. (December 2022). "Blood Pressure Targets in Adults With Hypertension: A Clinical Practice Guideline From the AAFP". American Family Physician. 106 (6): Online. ISSN 1532-0650. PMID 36521481.
  3. ^ Clarke, S. Lindsey (October 2023). "Hypertension in Adults: Initial Evaluation and Management". American Family Physician. 108 (4): 352–359. ISSN 1532-0650. PMID 37843942.
  4. ^ Cheung, Alfred K.; Chang, Tara I.; Cushman, William C.; Furth, Susan L.; Hou, Fan Fan; Ix, Joachim H.; Knoll, Gregory A.; Muntner, Paul; Pecoits-Filho, Roberto; Sarnak, Mark J.; Tobe, Sheldon W.; Tomson, Charles R.V.; Mann, Johannes F.E. (2021-03). "KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease". Kidney International. 99 (3): S1–S87. doi:10.1016/j.kint.2020.11.003. {{cite journal}}: Check date values in: |date= (help)
  5. ^ "Overview | Hypertension in adults: diagnosis and management | Guidance | NICE". www.nice.org.uk. 2019-08-28. Retrieved 2024-03-24.
  6. ^ Whelton, Paul K.; Carey, Robert M.; Aronow, Wilbert S.; Casey, Donald E.; Collins, Karen J.; Dennison Himmelfarb, Cheryl; DePalma, Sondra M.; Gidding, Samuel; Jamerson, Kenneth A.; Jones, Daniel W.; MacLaughlin, Eric J.; Muntner, Paul; Ovbiagele, Bruce; Smith, Sidney C.; Spencer, Crystal C. (2018-05-15). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults". Journal of the American College of Cardiology. 71 (19): e127–e248. doi:10.1016/j.jacc.2017.11.006.
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