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 (see Table - A Comparison of International Guidelines on Goal BP and Initial Drug Therapy for Adults With Hypertension).
| A Comparison of International
Guidelines on Goal BP and Initial Drug Therapy for Adults With Hypertension (modified from[1]) | |||
|---|---|---|---|
| Population | Goal BP, mmHg | Initial drug treatment options | |
| JNC8 | General ≥ 60y
General < 60y 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 ≥ 80y 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 < 80y
General ≥ 80y Diabetes CKD |
<140/90
<150/90 <130/80 <140/90 |
General: thiazide-type diuretic, beta-blocker (age,60y) 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
General ≥80 |
<140/90
<150/90 |
<55y: ACEI, or ARB
≥55y 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.