Table 2.
Comparison of latest divergent guideline-recommendations of ASH/ISH 2013 and JNC8 2014
| ASH/ISH 2013 | JNC8 2014 | |
|---|---|---|
| Recommended substances | • Thiazides • ARBs/ACEIs • CCBs |
• Thiazides • ARBs/ACEIs • CCBs |
| Recommended BP goals | Goal for patients ≥80 years: • SBP <140/90 mmHg for patients older than 80 years • <150/80 mmHg for some of the patients that are even older • If older patients (>80 years) have chronic kidney disease or diabetes melitus, BP should be lowered below 140/90 mmHg |
Goal for patients ≥60 years: • <150/90 mmHg, • no benefit to lower SBP <140 mmHg • If treatment is well tolerated and SBP is lowered <140 mmHg, no upwards adjustment is necessary |
| Recommendation for application | • First step: CCBs or thiazide diuretics as first drug choice • Second step: ARBs, ACEI (or CCB or thiazide if ACEI or ARB used first) as second drug • Third step: combination of CCB + ACEI or ARB + thiazide diuretic |
• Initiate thiazide-type diuretic or CCB, alone or in combination in black patients • Initiate thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination in non-black patients |
| Additional comments | • Consideration of ethnicity and race • Long-acting drugs should be preferred • Availability (government and other agencies) and affordability influences drug-choice |
• Different possible drug-strategies including a) Maximizing first medication before adding second, b) Add second medication before reaching maximum dose of first medication c) Start with two medication classes seperately or as fixed-dose combination |
Notes: ASH/ISH 2013 Clinical Practice Guidelines for the Management of Hypertension in the Community, A Statement by the American Society of Hypertension and the International Society of Hypertension, 2014 Evidence-Based Guideline for the Management of High Blood Pressure on Adults, Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC8).
Abbreviations: CCBs, calcium channel blockers; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; BP, blood pressure; SBP, systolic blood pressure ASH/ISH, American Society of Hypertension and the International Society of Hypertension.