ALGORITHM IN

PIT PDUI

HYPERTENSION
LUSIANI , MD

CARDIOVASCULAR DIVISION, INTERNAL MEDICINE DEPARTMENT

FACULTY OF MEDICINE, UNIVERSITY OF INDONESIA

Guidelines for
Hypertension
NICE
ESH
ASH/ISH
JNC 7, JNC 8

NICE Guideline 2011

CBPM 140/90 mmHg

& ABPM/HBPM
135/85 mmHg

CBPM 160/100 mmHg

& ABPM/HBPM
150/95 mmHg

Stage 1 hypertension

Stage 2 hypertension

If target organ damage present

or 10-year cardiovascular risk
> 20%
If younger than 40
years

Care pathway
Offer antihypertensive
drug treatment

Consider specialist
referral

Offer lifestyle interventions

Offer patient education and interventions to support adherence to treatment
Offer annual review of care to monitor blood pressure, provide support and
discuss lifestyle, symptoms and medication

Heartscore.
org

Aged
under
55 years

Aged over 55
years or black
person of African
or Caribbean
family origin of
any age
C2

Summary of
antihypertensive
drug treatment
Step 1

A + C2

Step 2

A+C+D

Step 3

Resistant hypertension

Step 4

A + C + D + consider further
diuretic3, 4 or alpha- or
beta-blocker5
Consider seeking expert
advice

Key
A ACE inhibitor or lowcost angiotensinII
receptor blocker (ARB)1
C Calcium-channel
blocker (CCB)
D Thiazide-like diuretic

10

European Society of
Hypertension (ESH) 2013

2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of

Hypertension 2013, 31:12811357

CV Risk
Stratification

2013 ESH/ESC
Guidelines
for the management
of arterial
hypertension. Journal of
2013 ESH/ESC
Guidelines
for the management
of arterial
Hypertension
2013, 31:12811357
hypertension

2013
2013
ESH/ESC
ESH/ESC
Guidelines
Guidelines
for the
for the
managemen
tmanageme
of arterial
nt of
hypertensio
n.arterial
Journal of
hypertensi
Hypertension
on
2013,
31:1281
1357

2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of

Hypertension 2013, 31:12811357

2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of

Hypertension 2013, 31:12811357

Monotherapy vs
Combination

2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of

Hypertension 2013, 31:12811357

Blood pressure goals in hypertensive patients

Recommendations
SBP goal for most
Patients at lowmoderate CV risk
Patients with diabetes
Consider with previous stroke or TIA
Consider with CHD
Consider with diabetic or non-diabetic CKD

<140 mmHg

SBP goal for elderly

Ages <80 years
Initial SBP 160 mmHg

140-150 mmHg

SBP goal for fit elderly

Aged <80 years

<140 mmHg

SBP goal for elderly >80 years with SBP

160 mmHg

140-150 mmHg

DBP goal for most

<90 mmHg

DB goal for patients with diabetes

<85 mmHg

2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of

Hypertension 2013, 31:12811357

2013
ESH/ESC
Guidelines
for the
managemen
t of arterial
hypertensio
n. Journal of
Hypertension
2013,
31:1281
1357

2013
ESH/ESC
Guidelines
for the
manageme
nt of
arterial
hypertensio
n. Journal of
Hypertension
2013,
31:1281
1357

ASH / ISH 2013

Michael A. Weber, MD
et al.
Clinical
Practice
Guidelines for the
Management
of
Hypertension in the
Community
A Statement by the
American Society of
Hypertension
and
the
International
Society
of
Hypertension.
The
Journal
of
Clinical
Hypertension

Michael A. Weber, MD
et al.
Clinical
Practice
Guidelines for the
Management
of
Hypertension in the
Community
A Statement by the
American Society of
Hypertension
and
the
International
Society
of
Hypertension.
The
Journal
of
Clinical
Hypertension

Michael A. Weber, MD et al. Clinical Practice Guidelines for the Management of Hypertension in the CommunityA
Statement by the American Society of Hypertension and the International Society of Hypertension. The Journal
of Clinical Hypertension

Michael A. Weber, MD et al. Clinical Practice

Guidelines for the Management of
Hypertension in the CommunityA
Statement by the American Society of
Hypertension and the International Society
of Hypertension. The Journal of Clinical
Hypertension

JNC 8 2013

Paul A. James, MD; Suzanne Oparil, MD;

et al.
2014 Evidence-Based Guideline for
the Management of High Blood
Pressure in Adults, Report From the
Panel Members Appointed to the
Eighth Joint National Committee
(JNC 8). jama.2013.284427

Paul A. James, MD; Suzanne Oparil, MD; et al. 2014 Evidence-Based Guideline for the Management of High Blood
Pressure in Adults, Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC
8). jama.2013.284427

Paul A. James, MD;

Suzanne Oparil, MD;
et al.
2014 EvidenceBased Guideline
for the
Management of
High Blood
Pressure in Adults,
Report From the
Panel Members
Appointed to the
Eighth Joint
National
Committee (JNC 8).
jama.2013.284427

JNC 7
Prehypertension (SBP 120-139 mm Hg or DBP 80-89 mm Hg)
LIFESTYLE MODIFICATIONS
Not at Goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with
diabetes or chronic kidney disease)

Without Compelling Indications

Stage 1 Hypertension
(SBP 140-159 or DBP 90-99 mm Hg)

Stage 2 Hypertension
(SBP 160 or DBP 100 mm Hg)

Thiazide-type diuretics for most;

may consider ACEI, ARB, BB,
CCB, or combination.

2-drug combinations for most

(usually thiazide-type diuretics and
ACEI, or ARB, or BB, or CCB).

Prehypertension

With Compelling Indications

Drug(s) for compelling indications

Other antihypertensive drugs
(diuretic, ACEI, ARB, BB, CCB)
as needed.

If not at goal BP, optimize dosages or add additional drugs until

goal BP is achieved. Consider consultation with hypertension specialist.

Which guidelines should we use?

JNC VII vs JNC VIII

THANK YOU