USA guidelines comparison

Recommendations for the use of CCBs

Patients without comorbidities

Patient Line of therapy JNC 81 ASH/ISH2 AHA/ACC/CDC3
General population 1st line Thiazide, ACEI, ARB or CCB, alone or in combination* ACEI or ARB Thiazide, ACEI, ARB or CCB or Combination*
2nd line Add any of the above not currently prescribed* Add CCB or thiazide Titrate and/or add drug from different class*
3rd line Add any of the above not currently prescribed* Combine CCB+ thiazide + ACEI/ARB Not specified
Elderly population aged ≥60 years 1st line Not specified CCB or thiazide Not specified
2nd line Add ACEI or ARB
3rd line Combine CCB + thiazide + ACEI/ARB
Black Patients 1st line Thiazide or CCB, alone or in combination* CCB or thiazide Thiazide or CCB
2nd line Add thiazide, ACEI, ARB or CCB if not currently prescribed* Add ACEI or ARB or combine CCB + thiazide Combination including Thiazide and/or CCB
3rd line Add thiazide, ACEI, ARB or CCB if not currently prescribed* Combine CCB + thiazide + ACEI/ARB Not specified
Stage 2 hypertension 1st line Not specified CCB/thiazide + ACEI/ARB Combination of 2 Thiazide, ACEI, ARB or CCB
2nd line Combine CCB + thiazide + ACEI/ARB Not specified
3rd line Not specified

*ACEIs and ARBs should not be used in combination

Patients with comorbidities

Patient Order of treatment JNC 8 recommendations1 ASH/ISH guidelines2 AHH/ACC/CDC advisory3#
Diabetes 1st Line Not specified ACEI or ARB (CCB or thiazide acceptable in black patients) ACEI, ARB, diuretic or CCB
2nd Line CCB or thiazide (ACEI or ARB in black patients)
3rd Line Thiazide or CCB
CKD 1st Line ARB or ACEI, alone or in combination with another drug class* ARB or ACEI 1st, 2nd, 3rd line: Thiazide, ACEI, ARB or CCB

Patients with albuminuria: ACEI, ARB
2nd Line Add thiazide, ACEI, ARB or CCB if not currently prescribed* CCB or thiazide
3rd Line Add thiazide, ACEI, ARB or CCB if not currently prescribed* Thiazide or CCB
Coronary artery disease 1st Line Not specified ß-blocker + ARB or ACEI ß-blocker, ACEI, ARB
2nd Line CCB or thiazide add Thiazide or CCB
3rd Line Thiazide or CCB Not specified
Stroke 1st Line Not specified ARB or ACEI Thiazide, ACEI or ARB or combination of thiazide and ARB
2nd Line CBB or thiazide
3rd Line Thiazide or CCB
Heart failure 1st Line Not specified Patients with symptomatic heart failure should usually receive an ARB or ACEI + ß-blocker + diuretic + spironolactone regardless of blood pressure. A dihydropyridine CCB can be added if needed for BP control. Heart failure with preserved EF: treatment of volume overload with diuretic; ACEI, ARB, ß-blocker

Heart failure with reduced EF: ACEI, ARB, ß-blocker or diuretic
2nd Line

*ACEIs and ARBs should not be used in combination

References

  1. James PA, et al. JAMA 2014;311:507-20.
  2. Weber M, et al. J Clin Hypertens 2014;16:14-26.
  3. Whelton PK, et al. Hypertension 2017 (online).