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User:Adh30/sandbox/BP drug goals

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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 )

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, ARC, or CCB

Black: thiazide-type diuretic, or CCB

Thiazide-type diuretic, ACEI, ARC, or CCB

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

beta-blocker, diuretic, CCB, ACEI, or ARB

ACEI, or ARB

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
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