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
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.

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[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.

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