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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