Table 2.
Recommendations from recent hypertension management guidelines.
| Name | Diagnosis | Target/Threshold | Treatment (Initial) | Treatment (Sequencing) |
|---|---|---|---|---|
|
| ||||
| ISH, Unger et al., 2020 [12] | ≥140/90 mm Hg (clinic BP). | Aim for at least a 20/10 mmHg BP reduction, ideally to <140/90 mmHg. Target BP <130/80 mmHg if tolerated and age <65 years (but >120/70 mmHg). | A+C (low dose) | A+C (full dose) A+C+D A+C+D+Spironolactone Treatment. Intensity stratified by CVD risk |
| NICE, 2019 [143] | ≥140/90 mm Hg (clinic BP). | Aim for <135/85 mmHg (aged <80) 145/85 mmHg (aged 80+). Use clinical judgement for people with frailty or multimorbidity | A or C or D | A+C or D A+C+D A+C+D+Spironolactone Treatment. Intensity stratified by CVD risk |
| JSH, Umemura et al., 2019 [53] | ≥140/90 mm Hg (clinic BP). | Aim for <130/80 (<75 years) or <125/75 (high-risk patients). targets for those (aged ≥75 years) are 140/90 and 135/85 mmHg, respectively. | A or C or D as first-line drugs. When a –20/–10 mmHg or greater decrease in BP is targeted, combination therapy should be considered. | Treatment intensity stratified by CVD risk. |
| ESC/ESH Task Force, 2018 [25] | ≥140/90 mm Hg (clinic BP). | Aim for <130/80 mmHg if age <65 years and <140/80 mmHg if age >65 years. | A+C or D (1 pill). Drug treatment may be considered when cardiovascular risk is very high due to established CVD in individuals with BP between 130–139/85–89 mmHg. | A+C+D (1 pill) A+C+D+Spironolactone (2 pills). Treatment intensity stratified by CVD risk |
| AHA/ACC, Whelton et al., 2017 [26] | ≥130/80 mm Hg | Aim for <130/80 mmHg | Single-agent (A or C or D) for BP between 130–140/80–90 mm Hg and high CV risk. Two first line agents (A+ C or D) if BP >140/90 mmHg. |
Add more drugs (D or spironolactone as necessary) |
ISH = International Society of Hypertension, NICE = The National Institute for Health and Care Excellence, JSH = Japanese Society of Hypertension, ESC = European Society of Cardiology, ESH = European Society of Hypertension, AHA = American Heart Association, ACC = American College of Cardiology, ABPM = Ambulatory Blood Pressure Monitoring, HBPM = Home Blood Pressure Monitoring, BP = Blood Pressure, A = ACE Inhibitor or angiotensin receptor blockers, C = Calcium Channel Blockers, D = Diuretics. In general, ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) is recommended in ideal settings for diagnosis of hypertension. The ABPM equivalent of clinic blood pressure for diagnosis of hypertension in general is 10 mmHg lower for 24h average or 5 mmHg lower for daytime average or 20 mmHg lower for nighttime average. The HBPM equivalent of clinic blood pressure in general is 5 mmHg lower.