Hypertension Management Algorithm: General Population—No Diabetes or CKD

Follow the diagram for hypertension treatment for the general population aged ≥18 years. These individuals do not have diabetes or CKD.

Age ≥18 yrs—no diabetes or CKD

①

Implement lifestyle interventions Continue throughout management

②

Set BP Goal Initiate BP-lowering therapy

Age ≥60 Age <60

BP Goal <150/90 BP Goal <140/90

Nonblack Black

Therapy choices—alone or in combo

Thiazide-type diuretic

ACEI

ARB

CCB

Avoid ACEI-ARB combo

Therapy choices—alone or in combo

Thiazide-type diuretic

CCB

Select treatment titration strategy

Maximize Drug 1 before adding Drug 2

Add Drug 2 before reaching max dose of Drug 1

Start with 2 drugs (separate or fixed dose)

Hypertension Management Algorithm: Individuals With Diabetes or CKD

Follow the diagram for hypertension treatment for the general population aged≥18 years who have diabetes or CKD.

Age ≥18 yrs with diabetes or CKD

①

Implement lifestyle interventions Continue throughout management

②

Set BP Goal Initiate BP-lowering therapy

All ages

Diabetes No CKD

All ages

CKD ± diabetes

BP Goal <140/90 BP Goal <140/90

Nonblack Black

Therapy choices—alone or in combo

Thiazide diuretic

Thiazide diuretic

ACEI CCB

ARB  

CCB  

Avoid ACEI-ARB combo

All races

Therapy choices—alone or in combowith other agents

ACEI

ARB

Avoid ACEI-ARB combo

Select treatment titration strategy

Maximize Drug 1 before adding Drug 2

Add Drug 2 before reaching max dose of Drug 1

Start with 2 drugs (separate or fixed dose)

Antihypertensive Therapy Dosing Strategies

By expert opinion, the panel recommended three dosing strategies for antihypertensive therapy

It is not known whether any one results in improved cardiovascular, cerebrovascular, or kidney outcomes, or mortality compared with another strategy

Each strategy is acceptable and should be individualized to the patient, including considerations for clinician and patient preferences, and drug tolerability

One antihypertensive drug may be replaced with another if it is perceived not to be effective or causes adverse effects

For each strategy:

Regularly assess BP Reinforce medication and lifestyle adherence Adjust treatment until goal BP is achieved and maintained At goal? Continue treatment and monitoring

Strategy A  

Start 1 drug

Not at goal?Move to next step

Titrate to max dose

Not at goal?Move to next step

Add 2nd drug & titrate to max dose

Avoid ACEI-ARB combo

Not at goal?Move to next step

Add 3rd drug & titrate to

 

max dose

Avoid ACEI-ARB combo

Strategy B  

Start 1 drug

Add 2nd drug before reaching max dose of 1st drug

Titrate both drugs to max dose

Not at goal?Move to next step

Add 3rd drug and titrate to max dose

Avoid ACEI-ARB combo

 

  

Strategy C

Start 2 drugs as 2 separate or fixed-dose combination

Not at goal?Move to next step

Add 3rd drug and titrate to max dose

Avoid ACEI-ARB combo