Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries.
| Guideline | Population | Goal blood pressure (mmHg) | Initial treatment options |
|---|---|---|---|
| ESC 2024 | General | 120–129/70–79 | BP >140/90: Two from different classes: preferably RAS-inhibitor (ACEI or ARB) with either thiazide diuretic/thiazide-like diuretic or dihydropyridine CCB. |
| ESH 2023 | General age <65
General age 65–79 General age ≥80 |
<130/80
<140 SBP <150 SBP |
BP <150/95: Lifestyle changes
BP ≥150/95 or has CVD risk factors or failed lifestyle changes: Two from different classes: thiazide-type diuretic, ACEI/ARB, and/or CCB |
| AAFP 2022 | 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 |
| WHO 2021 | General
High CVD risk, diabetes or CKD Previous CVD |
<140/90
<130 SBP <130 SBP |
BP ≥140/90 and low-risk for CVD: Two from different classes: thiazide-type diuretic, ACEI/ARB, and/or CCB
SBP ≥130 and CVD risk factors, diabetes or CKD: Two from different classes: thiazide-type diuretic, ACEI/ARB, and/or CCB SBP ≥130 and previous CVD: Two from different classes: thiazide-type diuretic, ACEI/ARB, and/or CCB |
| KDIGO 2021 | CKD
with kidney transplant |
<120 SBP
<130/80 |
CKD: ACEI/ARB
Kidney transplant: ARB or CCB |
| ISH 2020 | General
Age <65 Age ≥65 |
<140/90 (reduction by at least 20/10)
<130/80 <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 |
| VA/DoD 2020 | 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 | Age <80
Age ≥80 |
<140/90
<150/90 |
Age <55: ACEI/ARB
Age ≥55 or black: CCB |
| ADA 2018 | Diabetes
Diabetes with CVD risk |
<140/90
<130/80 |
ACEI/ARB, thiazide-like diuretic, and/or dihydropyridine CCB |
| ESC/ESH 2018 | 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 | 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 | 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 | 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
- CAD – coronary artery disease
- 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
- ISH – International Society for 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)
- SBP – systolic blood pressure
- WHO – World Health Organization
References
- ^ James, PA.; Oparil, S.; Carter, BL.; Cushman, WC.; Dennison-Himmelfarb, C.; et al. (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.
- McEvoy, John William; McCarthy, Cian P; Bruno, Rosa Maria; Brouwers, Sofie; Canavan, Michelle D; et al. (2024-08-30). "2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO)". European Heart Journal. doi:10.1093/eurheartj/ehae178. ISSN 0195-668X.
- Mancia, Giuseppe; Kreutz, Reinhold; Brunström, Mattias; Burnier, Michel; Grassi, Guido; et al. (2023-12-01). "2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)". Journal of Hypertension. 41 (12): 1874–2071. doi:10.1097/HJH.0000000000003480. hdl:11379/603005. ISSN 1473-5598. PMID 37345492.
- 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.
- Guideline for the pharmacological treatment of hypertension in adults (PDF). World Health Organization (WHO). 2021. ISBN 9789240033993. Retrieved 2024-05-26.
- Cheung, Alfred K.; Chang, Tara I.; Cushman, William C.; Furth, Susan L.; Hou, Fan Fan; et al. (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.
- Unger, Thomas; Borghi, Claudio; Charchar, Fadi; Khan, Nadia A.; Poulter, Neil R.; et al. (2020-05-06). "2020 International Society of Hypertension Global Hypertension Practice Guidelines". Hypertension. 75 (6): 1334–1357. doi:10.1161/HYPERTENSIONAHA.120.15026. hdl:10394/34842. ISSN 0194-911X.
- 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.
- "Hypertension in adults: diagnosis and management |". National Institute for Health and Clinical Excellence (NICE). 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.; et al. (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.
- Hackam, Daniel G.; Quinn, Robert R.; Ravani, Pietro; Rabi, Doreen M.; Dasgupta, Kaberi; et al. (May 2013). "The 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension". Canadian Journal of Cardiology. 29 (5): 528–542. doi:10.1016/j.cjca.2013.01.005.
- Flack, John M.; Sica, Domenic A.; Bakris, George; Brown, Angela L.; Ferdinand, Keith C.; et al. (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.