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 |
---|---|---|---|
ESH 2023 [2] | 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 [3] [4] | 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 [5] | 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 [6] |
CKD
with kidney transplant |
<120 SBP
<130/80 |
CKD: ACEI/ARB
Kidney transplant: ARB or CCB |
ISH 2020 [7] | 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 [8] | 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 [9] | Age <80
Age ≥80 |
<140/90
<150/90 |
Age <55: ACEI/ARB
Age ≥55 or black: CCB |
ADA 2018 [10] | Diabetes
Diabetes with CVD risk |
<140/90
<130/80 |
ACEI/ARB, thiazide-like diuretic, and/or dihydropyridine CCB |
ESC/ESH 2018 [11] | 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 [12] | 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 [13] | 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 [14] | Black, lower risk
Target organ damage or CVD risk |
<135/85
<130/80 |
Diuretic or CCB |
Abbreviations: