JNC 8 Has Finally Arrived
KEY POINTS
This guideline addresses blood pressure (BP) thresholds at which drug therapy should be initiated, BP targets during treatment, and choice of antihypertensive agents.
Recommendations are as follows:
For younger patients (age, <60 are="" based="" be="" bp="" but="" considered="" diastolic="" drug="" evidence.="" for="" goal="" hg.="" hg="" high-quality="" is="" mm="" on="" only="" or="" p="" should="" systolic="" the="" therapy="" thresholds="">
For older patients (age, ≥60), drug therapy should be considered for diastolic BP ≥90 mm Hg or systolic BP ≥150 mm Hg; the goal is <150 hg.="" mm="" p="">
For patients with diabetes and patients with chronic kidney disease, the threshold to initiate drug therapy is 140/90 mm Hg; the goal is <140 hg.="" mm="" p="">
In nonblack patients, acceptable initial drug-class choices are thiazide-type diuretics, calcium-channel blockers (CCBs), angiotensin-converting–enzyme (ACE) inhibitors, and angiotensin-receptor blocker (ARBs).
In black patients, acceptable initial drug-class choices are thiazide-type diuretics or CCBs.
Patients with chronic kidney disease generally should receive ACE inhibitors or ARBs.
When patients require escalation of therapy, either maximizing doses of individual drugs sequentially or combining several drugs at submaximal doses is acceptable.
WHAT'S CHANGED JNC 7, the predecessor of this guideline, was a comprehensive document that covered not only hypertension treatment, but also definitions of hypertension, issues in BP measurement, public health perspectives, lifestyle modification, and “special situations” in hypertension management. In contrast, JNC 8 focuses narrowly on drug treatment. Moreover, recommendations in JNC 7 were informed liberally by extrapolation from observational data and by expert opinion, as well as by data from randomized trials. In contrast, recommendations in JNC 8 mostly reflect randomized trial–level evidence, with explicit acknowledgement when a recommendation reflects only expert opinion. JNC 8 is very transparent about its guideline-writing process, which aspired to the Institute of Medicine's report on creation of trustworthy guidelines. Two specific differences regarding treatment are as follows:JNC 7 recommended a treatment threshold of 140/90 mm Hg regardless of age, whereas JNC 8 raises the systolic threshold at age 60. In addition, JNC 7 recommended a lower treatment threshold (130/80 mm Hg) for patients with diabetes or chronic kidney disease, but JNC 8 does not.In JNC 7, thiazide-type diuretics were recommended as initial drug therapy (unless compelling reasons dictated another drug class), with CCBs, ACE inhibitors, ARBs, and β-blockers as alternates. In JNC 8, the initial drug choice is broadened to four classes for nonblack patients and two classes for black patients. β-blockers are no longer recommended for initial therapy because they might afford less protection against stroke.
See more at: http://www.jwatch.org/na33228/2013/12/24/jnc-8-has-finally-arrived?query=etoc_jwcard#sthash.wkKfNXuc.dpuf
KEY POINTS
This guideline addresses blood pressure (BP) thresholds at which drug therapy should be initiated, BP targets during treatment, and choice of antihypertensive agents.
Recommendations are as follows:
For younger patients (age, <60 are="" based="" be="" bp="" but="" considered="" diastolic="" drug="" evidence.="" for="" goal="" hg.="" hg="" high-quality="" is="" mm="" on="" only="" or="" p="" should="" systolic="" the="" therapy="" thresholds="">
For older patients (age, ≥60), drug therapy should be considered for diastolic BP ≥90 mm Hg or systolic BP ≥150 mm Hg; the goal is <150 hg.="" mm="" p="">
For patients with diabetes and patients with chronic kidney disease, the threshold to initiate drug therapy is 140/90 mm Hg; the goal is <140 hg.="" mm="" p="">
In nonblack patients, acceptable initial drug-class choices are thiazide-type diuretics, calcium-channel blockers (CCBs), angiotensin-converting–enzyme (ACE) inhibitors, and angiotensin-receptor blocker (ARBs).
In black patients, acceptable initial drug-class choices are thiazide-type diuretics or CCBs.
Patients with chronic kidney disease generally should receive ACE inhibitors or ARBs.
When patients require escalation of therapy, either maximizing doses of individual drugs sequentially or combining several drugs at submaximal doses is acceptable.
WHAT'S CHANGED JNC 7, the predecessor of this guideline, was a comprehensive document that covered not only hypertension treatment, but also definitions of hypertension, issues in BP measurement, public health perspectives, lifestyle modification, and “special situations” in hypertension management. In contrast, JNC 8 focuses narrowly on drug treatment. Moreover, recommendations in JNC 7 were informed liberally by extrapolation from observational data and by expert opinion, as well as by data from randomized trials. In contrast, recommendations in JNC 8 mostly reflect randomized trial–level evidence, with explicit acknowledgement when a recommendation reflects only expert opinion. JNC 8 is very transparent about its guideline-writing process, which aspired to the Institute of Medicine's report on creation of trustworthy guidelines. Two specific differences regarding treatment are as follows:JNC 7 recommended a treatment threshold of 140/90 mm Hg regardless of age, whereas JNC 8 raises the systolic threshold at age 60. In addition, JNC 7 recommended a lower treatment threshold (130/80 mm Hg) for patients with diabetes or chronic kidney disease, but JNC 8 does not.In JNC 7, thiazide-type diuretics were recommended as initial drug therapy (unless compelling reasons dictated another drug class), with CCBs, ACE inhibitors, ARBs, and β-blockers as alternates. In JNC 8, the initial drug choice is broadened to four classes for nonblack patients and two classes for black patients. β-blockers are no longer recommended for initial therapy because they might afford less protection against stroke.
See more at: http://www.jwatch.org/na33228/2013/12/24/jnc-8-has-finally-arrived?query=etoc_jwcard#sthash.wkKfNXuc.dpuf
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