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 ) | |||
|---|---|---|---|
| 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, ARC, or CCB
Black: thiazide-type diuretic, or CCB Thiazide-type diuretic, ACEI, ARC, or CCB 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 |
beta-blocker, diuretic, CCB, ACEI, or ARB
ACEI, or ARB 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 |