Comparison of international blood pressure guidelines
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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 |
|---|---|---|---|
| AHA/ACC 2025[2] | General | <130/80 | BP ≥140/90: Two from different classes: thiazide diuretic, long-acting dihydropyridine CCB, and ACEi or ARB
BP ≥130/80: One of: thiazide diuretic, long-acting dihydropyridine CCB, ACEi or ARB |
| ESC 2024[3] | 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[4] | Age <65
Age 65–79 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[5][6] | 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[7] | 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[8] | CKD
with kidney transplant |
<120 SBP
<130/80 |
CKD: ACEi/ARB
Kidney transplant: ARB or CCB |
| ISH 2020[9] | 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[10] | 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[11] | Age <80
Age ≥80 |
<140/90
<150/90 |
Age <55: ACEi/ARB
Age ≥55 or black: CCB |
| ADA 2018[12] | Diabetes
Diabetes with CVD risk |
<140/90
<130/80 |
ACEi/ARB, thiazide-like diuretic, and/or dihydropyridine CCB |
| ESC/ESH 2018[13] | Age <65
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[14] | 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[15] | General age <80
General age ≥80 Diabetes CKD |
<140/90
<150/90 <130/80 <140/90 |
General: thiazide-type diuretic, beta-blocker (age < 60), 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[16] | Black, lower risk
Target organ damage or CVD risk |
<135/85
<130/80 |
Diuretic or CCB |
Abbreviations: