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 2022[2][3] | General | <140/90 | BP >140/90 and low-risk for CVD: Lifestyle changes
BP >140/90 and CVD risk factors or failed lifestyle changes: monotherapy with thiazide-type diuretic, ACEI/ARB, and/or CCB BP >160/100: two from different classes - thiazide-type diuretic, ACEI/ARB, and/or CCB |
KDIGO 2021[4] | CKD
with kidney transplant |
SBP <120
<130/80 |
CKD: ACEI/ARB
Kidney transplant: ARB or CCB |
VA/DoD 2020[5] | General
Age ≥60 Age ≥60 with Diabetes |
<130/90
<150/90 <140/90 |
Thiazide-type diuretic, ACEI/ARB, and/or CCB
Black: avoid monotherapy with ACEI/ARB |
NICE 2019[6] | Age <80
Age ≥80 |
<140/90
<150/90 |
Age <55: ACEI/ARB
Age ≥55 or black: CCB |
ADA 2018[7] | Diabetes
Diabetes with CVD risk |
<140/90
<130/80 |
ACEI/ARB, thiazide-like diuretic, and/or dihydropyridine CCB |
ESC/ESH 2018[8] | General age <65
General age ≥65 |
<130/80
<140/80 |
Thiazide-type diuretic, ACEI/ARB, and/or CCB
CAD: add beta-blocker Resistant hypertension: add spironolactone |
ACC/AHA 2017[9] | General | <130/80 | BP > 130/80: Lifestyle changes and monotherapy with thiazide-type diuretic, ACEI/ARB, and/or CCB
BP >20/10 above target: Lifestyle changes and two from different classes - thiazide-type diuretic, ACEI/ARB, and/or CCB |
JNC 8 2013[1] | General age ≥60
General age <60 |
<150/90
<140/90 <140/90 <140/90 |
Non-black: thiazide-type diuretic, ACEI/ARB, and/or CCB
Black: thiazide-type diuretic, and/or CCB Diabetes: thiazide-type diuretic, ACEI/ARB, and/or CCB CKD: ACEI/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/ARB Diabetes without additional risk : ACEI/ARB, thiazide, or DHPCCB CKD: ACEI, or ARB |
ISHIB 2010[10] | 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[edit]
- ^ 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. (March 2021). "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.
- ^ U.S. Department of Veterans Affairs. "VA/DoD clinical practice guideline for the diagnosis and management of hypertension in the primary care setting". VA/DoD Clinical Practice Guidelines. Retrieved 2024-03-25.
- ^ "Overview | Hypertension in adults: diagnosis and management | Guidance | NICE". www.nice.org.uk. 2019-08-28. Retrieved 2024-03-24.
- ^ Passarella, Pasquale; Kiseleva, Tatiana A.; Valeeva, Farida V.; Gosmanov, Aidar R. (2018-08-01). "Hypertension Management in Diabetes: 2018 Update". Diabetes Spectrum. 31 (3): 218–224. doi:10.2337/ds17-0085. ISSN 1040-9165. PMC 6092891. PMID 30140137.
- ^ Williams, Bryan; Mancia, Giuseppe; Spiering, Wilko; Agabiti Rosei, Enrico; Azizi, Michel; et al. (1 September 2018). "2018 ESC/ESH Guidelines for the management of arterial hypertension". European Heart Journal. 39 (33): 3021–3104. doi:10.1093/eurheartj/ehy339. PMID 30165516.
- ^ 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. PMID 29146535.
- ^ Flack, John M.; Sica, Domenic A.; Bakris, George; Brown, Angela L.; Ferdinand, Keith C.; Grimm, Richard H.; Hall, W. Dallas; Jones, Wendell E.; Kountz, David S.; Lea, Janice P.; Nasser, Samar; Nesbitt, Shawna D.; Saunders, Elijah; Scisney-Matlock, Margaret; Jamerson, Kenneth A. (November 2010). "Management of High Blood Pressure in Blacks: An Update of the International Society on Hypertension in Blacks Consensus Statement". Hypertension. 56 (5): 780–800. doi:10.1161/HYPERTENSIONAHA.110.152892. ISSN 0194-911X.