comparison of international blood pressure guidelines comparison of international blood pressure guidelines guidelines on the choice of agents and how best to step up treatment for various subgroups have changed over time and differ between countries (see table - a comparison of international guidelines on goal bp and initial drug therapy for adults with hypertension). a comparison of international guidelines on goal bp and initial drug therapy for adults with hypertension (modified from) population goal bp, mmhg initial drug treatment options jnc8 general ≥ 60y general < 60y diabetes ckd <150/90 <140/90 <140/90 <140/90 non-black: thiazide-type diuretic, acei, arb, or ccb black: thiazide-type diuretic, or ccb diabetes: thiazide-type diuretic, acei, arb, or ccb ckd: acei or arb esh/esc 2008 general nonelderly general elderly general ≥ 80y diabetes ckd ckd + proteinuria <140/90 <150/90 <150/90 <140/85 <140/90 <130/90 general: beta-blocker, diuretic, ccb, acei, or arb diabetes: acei, or arb ckd: acei, or arb chep 2013 general < 80y general ≥ 80y diabetes ckd <140/90 <150/90 <130/80 <140/90 general: thiazide-type diuretic, beta-blocker (age,60y) acei (non-black) or arb diabetes with additional risk : acei, or arb diabetes without additional risk : acei, arb, thiazide, or dhpccb ckd: acei, or arb ada 2013 diabetes <140/90 acei, or arb kdigo ckd no proteinuria ckd + proteinuria ≤140/90 ≤130/80 acei, or arb nice 2011 general <80 general ≥80 <140/90 <150/90 <55y: acei, or arb ≥55y or black: ccb ishib black, lower risk target organ damage or cvd risk <135/85 <130/80 diuretic or ccb abbreviations ada, american diabetes association; acei, angiotensin-converting enzyme inhibitor; arb, angiotensin receptor; ccb, calcium channel blocker; chep, canadian hypertension education program; ckd, chronic kidney disease; cvd, cardiovascular disease; dhpccb, dihydropyridine calcium channel blocker; esc, european society of cardiology; esh, european society of hypertension; ishib, international society for hypertension in blacks; jnc, joint national committee; kdigo, kidney disease: improving global outcome; nice, national institute for health and clinical excellence