Fig. 2 | Hypertension Research

Fig. 2

From: Key highlights of the Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025)

Fig. 2The alternative text for this image may have been generated using AI.

Stepwise antihypertensive therapy for hypertension: strategies for achieving target blood pressure. *1: For patients aged ≥75 years or with impaired renal function (CKD stage 4 or eGFR <30 mL/min/1.73 m²), treatment should generally be initiated at half the standard dose of monotherapy. *2: ARNI should not be used concomitantly with ACE inhibitors. A washout period of at least 36 h is required when switching from an ACE inhibitor to an ARNI. According to the product label, ARNI should not be used as the initial drug for antihypertensive therapy in principle. *3: Loop diuretics are preferred in patients with eGFR <30 mL/min/1.73 m². *4: ARNI and MR antagonists may be used as alternatives given their natriuretic effects. *5: Evaluate and address factors affecting lifestyle modifications and medication adherence, such as adverse effects or polypharmacy. ARB angiotensin II receptor blocker, ARNI angiotensin receptor–neprilysin inhibitor, ACE angiotensin-converting enzyme, BP blood pressure, CKD chronic kidney disease, eGFR estimated glomerular filtration rate, MR mineralocorticoid receptor. Translated and adapted from ref. [2]

Back to article page