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.
Guideline | Population | Goal BP, mmHg | Initial drug treatment options |
---|---|---|---|
AAFP | General - Strong Recommendation
General - Weak Recommendation |
<140/90
<135/85 |
Stage 1 >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 Stage 1 > 160/100: two from different classes - thiazide-type diuretic, ACEI, ARB, or CCB |
ACC/AHA 2017[4] | 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 |
JNC8[1] | 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:
- ACC – American College of Cardiology
- ACEI – angiotensin-converting enzyme inhibitor
- ADA – American Diabetes Association
- AHA – American Heart Association
- 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
- ^ 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.
- ^ Coles, Sarah; Fisher, Lynn; Lin, Kenneth W.; Lyon, Corey; Vosooney, Alexis A.; Bird, Melanie D. (2022-12). "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.
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(help) - ^ Clarke, S. Lindsey (2023-10). "Hypertension in Adults: Initial Evaluation and Management". American Family Physician. 108 (4): 352–359. ISSN 1532-0650. PMID 37843942.
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(help) - ^ 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). "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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