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Table 5 Recommended thresholds for drug treatment and initial drug therapy in recent major guidelines for hypertension

From: Methods underpinning national clinical guidelines for hypertension: describing the evidence shortfall

 

Thresholds for initiating drug treatment*

Initial drug therapy in uncomplicated patient (non-black patient aged over 55–60 years)†

Guideline

No target organ damage or risk factors

With risk factors (other than diabetes mellitus)

With target organ damage

With diabetes mellitus or renal disease

Recommendation

Grade of recommendation

CMA

≥160/90

≥160/90

≥160/90

≥140/90

Thiazides

A

WHO

≥150/95

≥140/90

≥140/90

≥130/85

Low dose monotherapy

 

VHA

>160 and/or>100

>160 and/or >100

≥130/85

≥130/85

Thiazides or β-blockers

 

SIGN

≥160/100

≥160/100

≥140/90

≥140/90

Thiazides

A

ESH

≥150/95

≥140/90

≥130/85

≥130/85

Low dose monotherapy or a combination

 

ICSI

≥160/100

≥140/90

≥130/85

≥130/85

Thiazides

 

JNC

≥140/90

≥140/90

≥130/80

≥130/80

Thiazides alone and/or combination ACE, ARB, β-blockers, CCB

 

SA

≥140/90

≥140/90

≥130/85

≥130/85

Thiazides

 

BHS

≥160/100

≥140/90

≥140/90

≥140/90

Thiazides or calcium channel blockers

C

NICE

≥160/100

≥160/100 or ≥ 140/90 if CHD§ risk ≥ 15% or CVDrisk ≥ 20%

≥140/90

Outside scope of guideline

Thiazides

A[34]

  1. * Blood pressure threshold in mmHg
  2. † Thiazides: low dose thiazide diuretics
  3. ACE: angiotensin-converting enzyme inhibitors
  4. ARB: angiotensin receptor blockers
  5. CCB: calcium channel blocker
  6. §CVD: cardiovascular disease
  7. ¶CHD: coronary heart disease