Table 22.1Thresholds for Initiating Therapy

Blood pressure (mmHg), except where noted

IndicatorNICE 2011ESH, ESC 2013ASH, ISH 2014AHA, ACC, CDC 20132014 hypertension guidelines, JNC 8
Definition of hypertension≥ 140/90; daytime ABPM (or home BP monitoring) of ≥ 135/85≥ 140/90≥ 140/90≥ 140/90Not addressed
Drug therapy in low-risk patients after nonpharmacological treatments≥ 160/100 or daytime ABPM ≥ 150/95≥ 140/90≥ 140/90≥ 140/90In persons < age 60 years, ≥ 140/90; in persons > age 60 years, ≥ 150/90
Beta blockers as first-line drugNo (step 4)YesNo (step 4)No (step 3)No (step 4)
DiureticsChlorthalidone, indapamideThiazides, chlorthalidone, indapamideThiazides, chlorthalidone, indapamideThiazidesThiazides, chlorthalidone, indapamide
Initiation of drug therapy with two drugsNot mentionedIn patients with markedly elevated BP≥ 160/100≥ 160/100≥ 160/100
BP targets< 140/90; for persons > age 80 years, < 150/90< 140/90; in patients < age 80 years, SBP of < 140; in fit patients, SBP of < 140; in patients > age 80 years, SBP of 140–150< 140/90; in patients > age 80 years, < 150/90< 140/90; lower targets may be appropriate in some patients, including the elderlyIn persons < age 60 years, < 140/90; in persons > age 60 years, < 150/90
BP target in patients with diabetes mellitusNot addressed< 140/85< 140/90< 140/90; lower targets may be considered< 140/90

Note: ABPM = ambulatory blood pressure measurement; ACC = American College of Cardiology; AHA = American Heart Association; ASH = American Society of Hypertension; BP = blood pressure; CDC = Centers for Disease Control and Prevention; ESC = European Society of Cardiology; ESH = European Society of Hypertension; ISH = International Society of Hypertension; JNC 8 = Eighth Joint National Committee; mmHg = millimeters of mercury, a measure of pressure; NICE = National Institute for Health and Care Excellence; SBP = systolic blood pressure.

From: Chapter 22, Management of Hypertension and Dyslipidemia for Primary Prevention of Cardiovascular Disease

Cover of Cardiovascular, Respiratory, and Related Disorders
Cardiovascular, Respiratory, and Related Disorders. 3rd edition.
Prabhakaran D, Anand S, Gaziano TA, et al., editors.
© 2017 International Bank for Reconstruction and Development / The World Bank.

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