What are the ASH/ISH guidelines for managing hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Joint guidelines were issued in 2013 by the American Society of Hypertension and the International Society of Hypertension (ASH/ISH) with the intent of providing an international primer with general information, especially for communities and countries with low resources. On their website, the ASH cautions that “these guidelines should be considered more as ‘an expert opinion piece,’ given that they are not systematically evidence-based and were not developed using guideline development protocol stipulated by the Institute of Medicine (IOM).” [132]

Treatment recommendations are given for hypertensive patients with or without another major medical condition are provided in Table 6, below. [138]

Table 6. American Society of Hypertension/International Society of Hypertension Treatment Recommendations (Open Table in a new window)

Patients Without Other Major Medical Condition

First-line Drugs

Added 2nd Drug (if needed to reach BP target)

Added 3rd Drug (if needed to reach BP target)

African ancestry

CCB or thiazide diuretic

ARB or ACEI

Combination of CCB plus ACEI or ARB plus thiazide diuretic

White and other non-African ancestry ages < 60 years

ARB or ACEI

CCB or thiazide diuretic

Combination of CCB plus ACEI or ARB plus thiazide diuretic

White and other non-African ancestry ages ≥60 years

CCB or thiazide diuretic; ARB or ACEI also effective

ARB or ACEI; CCB or thiazide diuretic if ARB or ACEI used first

Combination of CCB plus ACEI or ARB plus thiazide diuretic

Major medical condition

     

Diabetes (white and other non-African ancestry)

ARB or ACEI

CCB or thiazide diuretic

Alternative 2nd drug (CCB or thiazide diuretic)

Diabetes (African ancestry)

CCB or thiazide diuretic

ARB or ACEI

Alternative 1st drug (CCB or thiazide diuretic)

Chronic kidney disease

ARB or ACEI

CCB or thiazide diuretic

Alternative 2nd drug (CCB or thiazide diuretic)

Coronary artery disease

Beta-blocker plus ARB or ACEI

CCB or thiazide diuretic

Alternative 2nd drug (CCB or thiazide diuretic)

Stroke

ACEI or ARB

CCB or thiazide diuretic

Alternative 2nd drug (CCB or thiazide diuretic)

Symptomatic heart failure

Beta-blocker plus ARB or ACEI plus diuretic plus spironolactone regardless of BP; CCB can be added if needed for BP control

ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; BP = blood pressure; CCB = calcium channel blocker.


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