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.