Table 2. Blood pressure guidelines.
| WHO PEN2 | NICE 20112 | ESH/ESC 20133 | ASH/ISH 20144 | AHA/ACC/ CDC 20135 | US JNC 8 20146 | South Africa 20157 | Egypt 20138 | |
| Definition of hypertension (mmHg) | ≥ 140/90 | 140/90 and daytime ABPM (or home BP) ≥ 135/85 | ≥ 140/90 | ≥ 140/90 | ≥ 140/90 | Not addressed | ≥ 140/90 | ≥ 140/90 (high risk) – 150/95 (low risk) and daytime ABPM (or home BP) ≥ 135/85 |
| Drug therapy in low-risk patients after non-pharmacological treatment (mmHg) | > 160/100 | ≥ 160/100 or daytime ABPM ≥ 150/95 | ≥ 140/90 | ≥ 140/90 | ≥ 140/90 | < 60 years, ≥ 140/90; ≥ 60 years, ≥ 150/90 | ≥ 140/90 | ≥ 140/90 for high risk and ≥ 160/100 for low risk |
| First-line therapy | < 55 years, lowdose thiazide diuretic and/or ACE inhibitor; ≥ 55 years, CCB and/or low-dose thiazide diuretic | < 55 years, ACE inhibitor or ARB; ≥ 55 years or African ancestry, CCB | ACE inhibitor or ARB; beta-blocker; CCB; diuretic | Low-dose diuretic | ACE inhibitor or ARB; CCB; diuretic CCB/diuretic in people of African ancestry | ACE inhibitor or ARB; CCB; diuretic CCB/diuretic in people of African ancestry | Any of diuretics, betablockers, CCB, ACEIs or ARBs. preferably a thiazide diuretic. In elderly (> 65 years) or in blacks, start with diuretic or CCB. | |
| Beta-blockers as first-line drug | No | No (step 4) | Yes (in specific subgroups) | No (step 4) | No (step 3) | No (step 4) | No (step 4) | Yes, in specific e.g. young, particularly those with tachycardia |
| Diuretic | Thiazides, | Chlortalidone, indapamide | Thiazides, chlortalidone, indapamide | Thiazides, chlortalidone, indapamide | Thiazides | Thiazides, chlortalidone, indapamide | Thiazide or thiazide-like (indapamide) | Thiazides, chlorthalidone, amiloride or spironolactone |
| Initiate drug therapy with two drugs (mmHg) | Not mentioned | Not mentioned | In patients with markedly elevated BP or patients with high overall CV risk | ≥ 160/100 | ≥ 160/100 | ≥ 160/100 | ≥ 160/100 | Diuretic + beta-blockers/ CCB/ACEIs/ARBs if BP > 170/105 |
| Blood pressure target (mmHg) | < 140/90 | < 140/90; ≥ 80 years, < 150/90 | < 140/90; elderly < 80 years, SBP 140–150, SBP < 140 in fit patients; elderly ≥ 80 years, SBP 140–150 | < 140/90; ≥ 80 years, < 150/90 | < 140/90; lower targets may be appropriate in some patients, including the elderly | < 60 years, < 140/90; ≥ 60 years < 150/90 | < 140/90 | 150/95 in low-risk patients and in elderly (> 65 years). < 140/90: ≥ 2 risk factors, CKD, TOD < 130/80: HF or CKD when associated with proteinuria > 1 g/24 hours. |
| Blood pressure target in patients with diabetes mellitus (mmHg) | < 130/80 | Not addressed | < 140/85 | < 140/90 | < 140/90; lower targets may be considered | < 60 years, < 140/90; ≥ 60 years, < 150/90 | < 140/90 | < 140/90 mmHg or < 130/80 if associated with proteinuria > 1 g/24 hours |
ABPM, ambulatory blood pressure monitoring; ACC, American College of Cardiology; ACE inhibitor, angiotensin converting enzyme inhibitor; AHA, American Heart Association; ARB, angiotensin receptor blocker; ASH, American Society of Hypertension; BP, blood pressure; CCB, calcium channel blocker; CDC, Centers for Disease Control and Prevention; CKD, chronic kidney disease; CV, cardiovascular; ESC, European Society of Cardiology; ESH, European Society of Hypertension; ISH, International Society of Hypertension; NICE, National Institute for Health and Care Excellence; SBP, systolic blood pressure; TOD, target-organ damage; US JNC 8, Eighth US Joint National Committee; WHO PEN, World Health Organisation Package of Essential Non-communicable disease interventions.
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