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Hypertension in Patients With Comorbidities
Racial and Ethnic Differences in Treatment
I B-R In black adults with hypertension but without HF or CKD,
including those with DM, initial antihypertensive treatment
should include a thiazide-type diuretic or CCB.
I C-LD Two or more antihypertensive medications are recommended to
achieve a BP target of less than 130/80 mm Hg in most adults
with hypertension, especially in black adults with hypertension.
Pregnancy
I C-LD Women with hypertension who become pregnant, or are
planning to become pregnant, should be transitioned to
methyldopa, nifedipine, and/or labetalol during pregnancy.
III:
Harm
C-LD Women with hypertension who become pregnant should NOT
be treated with ACE inhibitors, ARBs, or direct renin inhibitors.
Older Persons
I A Treatment of hypertension with a SBP treatment goal of less
than 130 mm Hg is recommended for noninstitutionalized
ambulatory community-dwelling adults (≥65 years of age) with
an average SBP of 130 mm Hg or higher.
IIa C-EO For older adults (≥65 years of age) with hypertension and a
high burden of comorbidity and limited life expectancy, clinical
judgment, patient preference, and a team-based approach to assess
risk/benefit is reasonable for decisions regarding intensity of BP
lowering and choice of antihypertensive drugs.
Cognitive Decline and Dementia
IIa B-R In adults with hypertension, BP lowering is reasonable to prevent
cognitive decline and dementia.
Other Comorbidities (cont'd)
COR LOE
Recommendations
