Blood pressure treatment guidelines compared
| Guideline | Blood pressure goals (mm Hg) | Initial drug therapy | |
|---|---|---|---|
| JNC 7 (2003)3 | General population | < 140/90 | Thiazide |
| Chronic kidney disease | < 130/80 | ACE inhibitor or ARB | |
| Diabetes mellitus | < 130/80 | Thiazide, CCB, beta-blocker, ACE inhibitor, or ARB With proteinuria: ACE inhibitor or ARB | |
| NICE (2011)25 | General population | < 140/90 | Black or age > 55: CCB, thiazide Nonblack or age ≤ 55: ACE inhibitor or ARB With proteinuria: ACE inhibitor or ARB |
| Elderly (age ≥ 80) | < 150/90 | ||
| Chronic kidney disease | < 140/90 | ||
| Diabetes mellitus | < 140/90a | Black: ACE inhibitor or ARB + CCB or thiazide Nonblack: ACE inhibitor or ARB With proteinuria: ACE inhibitor or ARB | |
| KDIGO (2012)29 | Chronic kidney disease with albuminuria < 30 mg/24 hoursb | ≤ 140/90 | |
| ≥ 30 mg/24 hoursb | ≤ 130/80 | ACE inhibitor or ARB | |
| ESH/ESC (2013)24 | General population | < 140/90 | Thiazide, CCB, beta-blocker, ACE inhibitor or ARB |
| Elderly (age ≥ 80) | < 150/90 | ||
| Chronic kidney disease | < 140/90 | Thiazide, CCB, beta-blocker, ACE inhibitor, or ARB With proteinuria: ACE inhibitor or ARB | |
| Diabetes mellitus | < 140/85 | ||
| ASH/ISH (2014)28 | General population | < 140/90 | Black: CCB or thiazide Nonblack, age < 60: ACE inhibitor or ARB Nonblack, age ≥ 60: CCB or thiazide |
| Elderly (age ≥ 80) | < 150/90 | ||
| Chronic kidney disease | < 140/90 | ACE inhibitor or ARB | |
| Diabetes mellitus | < 140/90 | ACE inhibitor or ARB Black: acceptable to start with CCB or thiazide | |
| JNC 8 (2014)5 | General population | < 140/90 | Black, including those with diabetes: thiazide, CCB Nonblack, including those with diabetes: thiazide, CCB, ACE inhibitor, or ARB |
| Older patients (age ≥ 60) | < 150/90 | ||
| Diabetes mellitus | < 140/90 | ||
| Chronic kidney disease | < 140/90 | ACE inhibitor or ARB | |
| Hypertension Canada (2018)12 | General population | < 140/90 | Thiazide, CCB, beta-blocker (in age < 60), ACE inhibitor (in nonblack), or ARB |
| Chronic kidney disease | < 140/90 | With proteinuria: ACE inhibitor or ARB | |
| Diabetes mellitus | < 130/80 | Thiazide, CCB, ACE inhibitor, or ARB With proteinuria or renal disease: ACE inhibitor or ARB | |
| ACC/AHA (2017)1 | General population | < 130/80 | Thiazide, CCB, ACE inhibitor, or ARB Black including diabetes, but no heart failure or chronic kidney disease: CCB, thiazide |
| Older patients (age ≥ 65) | < 130/80c | ||
| Chronic kidney disease | < 130/80 | Thiazide, CCB, ACE inhibitor, or ARB With proteinuria: ACE inhibitor or ARB | |
| Diabetes mellitus | < 130/80 | ||
| ACP/AAFP (2017)27 | Older patients (age ≥ 60) | < 150/90 | |
| ADA (2017)30 | Diabetes mellitus | < 140/90 | Thiazide, CCB, ACE inhibitor, or ARB With proteinuria: ACE inhibitor or ARB |
↵a < 130/80 if chronic kidney disease and diabetes mellitus;
↵b Or equivalent;
↵c Unless alternative goal determined by physician.
AAFP = American Academy of Family Physicians; ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; ACP = American College of Physicians; ADA = American Diabetes Association; AHA = American Heart Association; ARB = angiotensin II receptor blocker; ASH = American Society of Hypertension; CCB = calcium channel blocker; ESC = European Society of Cardiology; ESH = European Society of Hypertension; ISH = International Society of Hypertension; JNC = Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; KDIGO = Kidney Disease: Improving Global Outcomes; NICE = National Institute for Health and Care Excellence