-
Initiate drug tx if SBP ≥140 or DBP ≥90 [E]; goal is <140/90 [E]1 - Initial (or add-on) tx should include either an ACEI or ARB2 (regardless of race3/DM status) [B] + lifestyle
- At 1 mo: If not at goal, increase dose or add 2nd drug (thiazide diuretic or CCB); do not combine ACEI + ARB. Reassess, add/titrate 3rd drug if needed.4
Footnotes 1 Applies to pts <70 yo w/ GFR <60, or pts of any age w/ albuminuria (>30 mg alb/g of Cr) at any GFR level. No BP goal recommended for pts 70 yrs or older w/ GFR <60; tx for such pts should be individualized.
2 Use of ACEIs/ARBs in CKD pts requires monitoring of lytes & Cr; dose reduction/discontinuation may be required for safety reasons.
3 In black pts w/ CKD & proteinuria, ACEI or ARB is recommended 1st-line; if no proteinuria, choice of initial tx less clear, & may include thiazide, CCB, ACEI, or ARB. If ACEI or ARB is not used initially, then add-on tx may include ACEI or ARB.
4 If goal BP cannot be reached, drugs from non-recommended classes may be used; consultation w/ HTN specialist may be indicated [E].
-
Initiate drug tx if SBP ≥140 or DBP ≥90 [E]; goal is <140/90 [E] - Nonblack pts initial tx: thiazide diuretic, CCB, ACEI, or ARB [B]5 + lifestyle
- Black pts initial tx: thiazide diuretic or CCB [C] + lifestyle
- At 1 mo: If not at goal, increase dose or add 2nd drug; do not combine ACEI + ARB. Reassess, add/titrate 3rd drug if needed.6
Footnotes 5 All 4 drug classes yield comparable effects on overall mortality & CV/cerebrovasc/kidney outcomes; however, for HF outcomes, initial thiazide tx more effective than CCB or ACEI, and ACEI more effective than CCB.
6 If goal BP cannot be reached, drugs from non-recommended classes may be used; consultation w/ a HTN specialist may be indicated [E].
Initiate drug tx if SBP ≥1507 or DBP ≥90 [A]; goal is <150/907 [A]; no need to adjust existing tx if SBP <140 and tx is well tolerated [E] - Nonblack pts initial tx: thiazide diuretic, CCB, ACEI, or ARB [B]8 + lifestyle
- Black pts initial tx: thiazide diuretic or CCB [B] + lifestyle
- At 1 mo: If not at goal, increase dose or add 2nd drug; do not combine ACEI + ARB. Reassess, add/titrate 3rd drug if needed.9
Footnotes 7 Some panel members recommend retaining SBP goal of <140 in pts ≥60 yo, esp in high-risk groups like black persons, CVD (incl. stroke), and multiple risk factors [E].
8 All 4 drug classes yield comparable effects on overall mortality & CV/cerebrovasc/kidney outcomes; however, for HF outcomes, initial thiazide tx more effective than CCB or ACEI, and ACEI more effective than CCB.
9 If goal BP cannot be reached, drugs from non-recommended classes may be used; consultation w/ a hypertension specialist may be indicated [E].
Initiate drug tx if SBP ≥140 or DBP ≥90 [A][E];10 goal <140/90 [A][E]10 - Nonblack pts initial tx: thiazide diuretic, CCB, ACEI, or ARB [B]11 + lifestyle
- Black pts initial tx: thiazide diuretic or CCB [B] + lifestyle
- At 1 mo: If not at goal, increase dose or add 2nd drug; do not combine ACEI + ARB. Reassess, add/titrate 3rd drug if needed.12
Footnotes 10 [A] applies only to DBP goal in 30-59 yo pts, [E] applies to SBP goal, and DBP goal in 18-29 yo pts.
11 All 4 drug classes yield comparable effects on overall mortality & CV/cerebrovasc/kidney outcomes; however, for HF outcomes, initial thiazide tx more effective than CCB or ACEI, and ACEI more effective than CCB.
12 If goal BP cannot be reached, drugs from non-recommended classes may be used; consultation w/ a HTN specialist may be indicated [E].
|