Table 2.
Population-intervention-comparator specifications of reference recommendations
| Code1 | Population | Intervention | Comparator |
|---|---|---|---|
|
ACC-1 ESC-1 |
All patients | Blood pressure measurement with specific instructions on cuff size and body position of patients | Blood pressure measurement without specific instructions |
|
ACC-2 ESC-2 |
Adults with suspected hypertension | Diagnosis based on at least 2 blood pressure measurements per office visit from at least 2 office visits | Diagnosis based on single blood pressure measurement and/or single office visit |
| ACC-3 | Adults with suspected hypertension | Diagnosis based on the office (non-automated) systolic blood pressure measurement of > 130 mm Hg and/or diastolic blood pressure measurement of > 80 mm Hg | Diagnosis based on thresholds other than systolic blood pressure measurement of > 130 mm Hg and/or diastolic blood pressure measurement of > 80 mm Hg |
| ESC-3 | Adults with suspected hypertension | Diagnosis based on the office (non-automated) systolic blood pressure measurement of > 140 mm Hg and/or diastolic blood pressure measurement of > 90 mm Hg | Diagnosis based on thresholds other than systolic blood pressure measurement of > 140 mm Hg and/or diastolic blood pressure measurement of > 90 mm Hg |
| ACC-4 | Adults with suspected hypertension but without diagnostic uncertainty and blood pressure variability | Ambulatory blood pressure monitoring to confirm the diagnosis of hypertension | Diagnosis based on office blood pressure measurements alone |
| ACC-5 | Adults with suspected hypertension but without diagnostic uncertainty and blood pressure variability | Home blood pressure monitoring to confirm the diagnosis of hypertension | Diagnosis based on office blood pressure measurements alone |
|
ACC-6 ESC-4 |
Adults with suspected hypertension but with diagnostic uncertainty | Performance of ambulatory blood pressure monitoring to confirm the diagnosis of hypertension | No performance of ambulatory blood pressure monitoring to confirm the diagnosis of hypertension |
| ESC-5 | Adults with suspected blood pressure variability | Performance of ambulatory blood pressure monitoring to confirm the diagnosis of hypertension | No performance of ambulatory blood pressure monitoring to confirm the diagnosis of hypertension |
|
ACC-7 ESC-6 |
Adults newly diagnosed with hypertension | Performance of baseline blood chemistry (sodium, potassium, creatinine) | No performance of baseline blood chemistry |
|
ACC-8 ESC-7 |
Adults newly diagnosed with hypertension | Performance of baseline fasting blood glucose level test | No performance of baseline fasting blood glucose level test |
|
ACC-9 ESC-8 |
Adults newly diagnosed with hypertension | Performance of baseline fasting lipid profile test | No performance of baseline fasting lipid profile test |
|
ACC-10 ESC-9 |
Adults newly diagnosed with hypertension | Performance of baseline dipstick urinalyis for the detection of blood and protein | No performance of baseline dipstick urinalyis |
|
ACC-11 ESC-10 |
Adults newly diagnosed with hypertension | Performance of baseline electrocardiography | No performance of baseline electrocardiography |
|
ACC-12 ESC-11 |
Adults newly diagnosed with hypertension | Performance of baseline serum hemoglobin or hematocrit level test | No performance of baseline serum hemoglobin or hematocrit level test |
| ACC-13 | Adults newly diagnosed with hypertension | Performance of baseline serum calcium level test | No performance of baseline serum calcium level test |
|
ACC-14 ESC-12 |
Adults newly diagnosed with hypertension | Performance of baseline serum uric acid level test | No performance of baseline serum uric acid level test |
| ESC-13 | Adults newly diagnosed with hypertension | Performance of urine testing for albumin: creatinine ratio to quantify baseline albumin level | No performance of urine testing to quantify baseline albumin level |
| ACC-15 | Adults newly diagnosed with hypertension | Performance of urine testing for albumin: creatinine ratio to quantify baseline albumin level | Performance of 24-h urine testing to quantify baseline albumin level |
|
ACC-16 ESC-14 |
Adults newly diagnosed with hypertension | Targeted screening for potential underlying causes of secondary hypertension | No screening for potential underlying causes of secondary hypertension |
|
ACC-17 ESC-15 |
Adults newly diagnosed with hypertension and with suspected structural heart disease | Performance of baseline echocardiography | No performance of baseline echocardiography |
|
ACC-18 ESC-16 |
Adults with hypertension and concurrent overweight/obesity | Counseling for weight loss | No counseling for weight loss |
|
ACC-19 ESC-17 |
Adults with hypertension | Counseling for dietary modifications | No counseling for dietary modifications |
|
ACC-20 ESC-18 |
Adults with hypertension | Counseling for regular physical activity | No counseling for regular physical activity |
|
ACC-21 ESC-19 |
Adults with hypertension who smoke | Counseling for smoking cessation | No counseling for smoking cessation |
|
ACC-22 ESC-20 |
Adults with hypertension | Counseling for salt/sodium restriction | No counseling for salt/sodium restriction |
|
ACC-23 ESC-21 |
Adults with hypertension and heavy alcohol consumption | Counseling to moderate alcohol consumption | No counseling on alcohol consumption |
| ACC-24 | Adults age 18–60 years with hypertension but without diabetes, coronary artery disease, and chronic kidney disease | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ESC-22 | Adults age 18–60 years with hypertension but without diabetes, coronary artery disease, and chronic kidney disease | Goal blood pressure of < 140/90 mm Hg | Other goal blood pressure |
| ACC-25 | Adults age 60–80 years with hypertension but without diabetes, coronary artery disease, and chronic kidney disease | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ESC-23 | Adults age 60–80 years with hypertension but without diabetes, coronary artery disease, and chronic kidney disease | Goal blood pressure of < 140/90 mm Hg | Other goal blood pressure |
| ACC-26 | Adults age > 50 years with increased risk of cardiovascular disease | Goal systolic blood pressure of < 130 mm Hg | Other goal systolic blood pressure |
| ACC-27 | Adults age > 75–80 years with hypertension | Goal blood pressure of < 130/80 mm Hg | Higher goal blood pressure |
| ESC-24 | Adults age > 75–80 years with hypertension | Goal blood pressure of < 140/90 mm Hg | Other goal blood pressure |
| ACC-28 | Adults with hypertension and concurrent diabetes | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ESC-25 | Adults with hypertension and concurrent diabetes | Goal blood pressure of < 140/80 mm Hg | Other goal blood pressure |
| ACC-29 | Adults with hypertension and concurrent chronic kidney disease but without proteinuria and diabetes | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ESC-26 | Adults with hypertension and concurrent chronic kidney disease but without proteinuria and diabetes | Goal blood pressure of < 140/90 mm Hg | Other goal blood pressure |
|
ACC-30 ESC-27 |
Adults with hypertension and concurrent chronic kidney disease with proteinuria | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ACC-31 | Adults with hypertension and concurrent chronic kidney disease and diabetes | Goal blood pressure of < 130/80 mm Hg | Other goal blood pressure |
| ESC-28 | Adults with hypertension and concurrent chronic kidney disease and diabetes | Goal blood pressure of < 140/90 mm Hg | Other goal blood pressure |
|
ACC-32 ESC-29 |
Adults age < 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | Thiazide diuretics as an option for first-line therapy | Not recommending thiazide diuretics as an option for first-line therapy |
|
ACC-33 ESC-30 |
Adults age ≥ 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | Thiazide diuretics as an option for first-line therapy | Not recommending thiazide diuretics as an option for first-line therapy |
|
ACC-34 ESC-31 |
Adults age < 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
|
ACC-35 ESC-32 |
Adults age ≥ 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
|
ACC-36 ESC-33 |
Adults age < 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
|
ACC-37 ESC-34 |
Adults age ≥ 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
|
ACC-38 ESC-35 |
Adults age < 60 years with hypertension but with no comorbidity requiring initial pharmacotherapy | Calcium channel blockers as an option for first-line therapy | Not recommending calcium channel blockers as an option for first-line therapy |
|
ACC-39 ESC-36 |
Adults age ≥ 60 years of age with hypertension but with no comorbidity requiring initial pharmacotherapy | Calcium channel blockers as an option for first-line therapy | Not recommending calcium channel blockers as an option for first-line therapy |
| ACC-40 | Adults with hypertension but with no comorbidity requiring initial pharmacotherapy | Not recommending beta-blockers as an option for first-line therapy | Beta-blockers as an option for first-line therapy |
| ESC-37 | Adults with hypertension but with no comorbidity requiring initial pharmacotherapy | Beta-blockers as an option for first-line therapy | Not recommending beta-blockers as an option for first-line therapy |
|
ACC-41 ESC-38 |
Adults with hypertension but with no comorbidity requiring initial pharmacotherapy | Thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers are preferred over beta-blockers as an option for first-line therapy | Beta-blockers as equally preferred option as thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers for first-line therapy |
|
ACC-42 ESC-39 |
Adults with hypertension and concurrent diabetes | ACE inhibitors or ARBs as an option for first-line therapy | Not recommending ACE inhibitors or ARBs as an option for first-line therapy |
| ACC-43 | Adults with hypertension and concurrent diabetes | ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics as the preferred option for first-line therapy | Other drug therapies are preferred over ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics as an option for first-line therapy |
|
ACC-44 ESC-40 |
Adults with hypertension and concurrent chronic kidney disease | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
|
ACC-45 ESC-41 |
Adults with hypertension and concurrent chronic kidney disease | ARBs as equally preferred option as ACE inhibitors for first-line therapy | ACE inhibitors are preferred over ARBs as an option for first-line therapy |
| ACC-46 | Adults with hypertension and concurrent chronic kidney disease but without moderately increased albuminuria | Thiazide diuretics or calcium channel blockers as equally preferred option as ACE inhibitors or ARBs for first-line therapy | ACE inhibitors or ARBs are preferred over thiazide diuretics or calcium channel blockers as an option for first-line therapy |
|
ACC-47 ESC-42 |
Adults with hypertension and concurrent chronic kidney disease with at least moderately increased albuminuria | ACE inhibitors or ARBs as the preferred option for first-line therapy | Drug therapies other than ACE inhibitors or ARBs as equally or more preferred option for first-line therapy |
| ACC-48 | Adults with hypertension and concurrent chronic kidney disease intolerant to ACE inhibitors | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
| ACC-49 | Adults with hypertension and concurrent chronic kidney disease intolerant to ACE inhibitors | ARBs as the preferred option for first-line therapy | Drug therapies other than ARBs as equally or more preferred option for first-line therapy |
|
ACC-50 ESC-43 |
Adults with hypertension and concurrent coronary artery disease (ischemic heart disease) but without prior acute coronary syndrome | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
| ACC-51 | Adults with hypertension and prior acute coronary syndrome | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
|
ACC-52 ESC-44 |
Adults with hypertension and concurrent coronary artery disease (ischemic heart disease) but without prior acute coronary syndrome | ARBs as equally preferred option as ACE inhibitors for first-line therapy | ACE inhibitors are preferred over ARBs as an option for first-line therapy |
| ACC-53 | Adults with hypertension and prior acute coronary syndrome | ARBs as equally preferred option as ACE inhibitors for first-line therapy | ACE inhibitors are preferred over ARBs as an option for first-line therapy |
| ESC-45 | Adults with hypertension and concurrent coronary artery disease (ischemic heart disease) but without prior acute coronary syndrome | Beta-blockers or calcium channel blockers as equally or more preferred option than ACE inhibitors or ARBs for first-line therapy | ACE inhibitors or ARBs are preferred over beta-blockers or calcium channel blockers as an option for first-line therapy |
| ESC-46 | Adults with hypertension and prior acute coronary syndrome | Beta-blockers, ACE inhibitors, or ARBs as the preferred option for first-line therapy | Other drug therapies as equally or more preferred option than beta-blockers, ACE inhibitors, or ARBs for first-line therapy |
|
ACC-54 ESC-47 |
Adults with hypertension and concurrent coronary artery disease (ischemic heart disease) but without prior acute coronary syndrome intolerant to ACE inhibitors | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
| ACC-55 | Adults with hypertension and prior acute coronary syndrome intolerant to ACE inhibitors | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
| ESC-48 | Adults with hypertension and concurrent coronary artery disease (ischemic heart disease) but without prior acute coronary syndrome intolerant to ACE inhibitors | Beta-blockers or calcium channel blockers as the preferred option for first-line therapy | ARBs as equally or more preferred option than beta-blockers or calcium channel blockers for first-line therapy |
|
ACC-56 ESC-49 |
Adults with hypertension and recent acute coronary syndrome | Beta-blockers as an option for first-line therapy | Not recommending beta-blockers as an option for first-line therapy |
|
ACC-57 ESC-50 |
Adults with hypertension and concurrent heart failure | ACE inhibitors as an option for first-line therapy | Not recommending ACE inhibitors as an option for first-line therapy |
|
ACC-58 ESC-51 |
Adults with hypertension and concurrent heart failure | Beta-blockers as an option for first-line therapy | Not recommending beta-blockers as an option for first-line therapy |
| ACC-59 | Adults with hypertension and concurrent heart failure intolerant to ACE inhibitors | ARBs as an option for first-line therapy | Not recommending ARBs as an option for first-line therapy |
ACE: Angiotensin-converting enzyme; ARB: Angiotensin II receptor blocker
1Reference recommendations with code starting with ACC were generated from the 2017 ACC/AHA hypertension guideline [22] whereas reference recommendations with code starting with ESC were generated from the 2018 ESC/ESH hypertension guideline [23]