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.

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	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 2 > 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

^ ^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. (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.
^ Clarke, S. Lindsey (October 2023). "Hypertension in Adults: Initial Evaluation and Management". American Family Physician. 108 (4): 352–359. ISSN 1532-0650. PMID 37843942.
^ 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)
^ "Overview | Hypertension in adults: diagnosis and management | Guidance | NICE". www.nice.org.uk. 2019-08-28. Retrieved 2024-03-24.
^ 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.

[jnc8-1] 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.

[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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