The drugs covered in this unit have a variety of mechanisms of action including diuresis, sympathoplegia, vasodilation, and antagonism of angiotensin, and many agents are available in most categories. The jnc 7 guidelines were a comprehensive expert consen sus of the prevention, detection, evaluation, and treatment of high blood pressure in adults chobanian 2003, whereas the jnc 8 guidelines were an evidencebased, focused set of recommendations. The lowest recorded bp at the most recent a office visit with internal medicine, family medicine, endocrinology, cardiology, and nephrology or. According to jnc 8, which category of patients are recommended to start hypertension pharmacotherapy at 15090mmhg. Conducting studies of drugs to treat patients on a background of multiple antihypertensive drugs guidance for industry july 2018. Past htn guidelines jnc7 guidelines recommended five medication. A view from a member of jnc 7 benefit either as 1 st or 2 ndline therapy ctd twice as potent as hctz ctd longer duration of action hctz 2550 mgd vs. Jnc 8 report on prevention, evaluation, and treatment of. The panel members appointed to jnc 8 were selected from more. Northshore medical group hypertension guidelines target values depend on age and comorbidities a hypertensive patient is considered to be out of control if the following bp reading is above target. Your blood pressure is the force of your blood moving against the walls of your arteries. Hypothetical jnc 8 recommendations goal bp likely to be refined relaxed for population subgroups, particularly for those 80 and those with dm. Ace inhibitorsarbs are first choice drugs in patients with ckd irrespective of ethnic backgrounds.
The eighth joint national committee jnc 8 guidelines on hypertension have generated great interest among physicians. Compared with previous hypertension treatment guidelines, the jnc 8 guidelines advise higher blood pressure goals and less use of several types of antihypertensive medications. What are the acpaafp and jnc 8 guidelines for initiating. Joint national committee jnc 8 recently released evidencebased recommendations on treatment thresholds, goals, and medications in. Choice of drug therapy in primary essential hypertension. Set bp goal, initiate bp lowering medication based on algorithm.
Aafp was not involved in the development of the new guideline. The eighth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 8 recommends for patients aged 60 years. Hypertension can lead to many complications, including. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd. Journal for drugs and medicines october 2011april2012. Reference card from the seventh report of the joint national.
See the synopsis section for a summary of the updated hypertension treatment recommendations from the eighth joint national committee jnc 8. Jnc 8 uses 14090 for patients with diabetes or chronic kidney disease. Impact of treating hypertension moser m, hebert pr. Jnc 8 guidelines for the management of hypertension in adults. These trials are often discussed in isolation, but their data have. Effects of ace inhibitors, calcium antagonists, and other bloodpressurelowering drugs. Hypertension causes your blood pressure to get so high that your heart has to work much harder than normal. In the jnc 8 panel guideline, the goal bp changes from jnc guidelines for hypertension. A half yearly scientific international online journal for drugs and medicines.
Worldwide prevalence estimates for htn may be as much as 1 billion. Jnc 8 hypertension guideline algorithm initial drugs of. Joint national committee jnc guidelines for hypertension. These guidelines differ from those published in 2003 the jnc 7 in the document format, bloodpressure cutoff values, and recommendations for antihypertensive drug use. Weve taken what the science shows image mnemonics work but weve boosted the effectiveness by building and associating memorable characters, interesting audio stories, and builtin quizzing.
Reduced role for betablockers as initial therapy still pre eminent for hfref and cad, particularly atenolol. Jnc 8 bp target of 80 yrs hypertension in the very elderly trial. Contents 2 clinical disorders of hypertension classification of bp drugs used in hypertension jnc 8 methodology jnc 8. Initial combination therapy is recommended if bp is greater than 2010mm hg above goal at blood pressure goal. Jnc 8 raises the systolic threshold to 150 mmhg at age 60. Chlorthalidone recommended over hctz, but preeminence as first line therapy might be challenged. Patients will be asking about the new joint national committee jnc 8 hypertension guidelines, which were published in the journal of the american medical association. High blood pressure causes hardening and thickening of arteries. Using the lower threshold as defined by the 2017 accaha guide lines, the prevalence of hypertension for patients 2044 years of age is 30% in men and 19% in women. Jnc 8 guidelines recommended a higher blood pressure.
Jnc 7 becoming increasingly outdated and the 2011 institute of medicine report calling for highquality evidencebased guidelines,7, 8 the eighth joint national committee jnc 8 was initially appointed to create an updated treatment guideline for hypertension under the auspices of the national institutes of health nih. Betablockers are no longer considered as firstline drugs, according to jnc 8 guidelines for hypertension. Hypertension guidelines from the eighth joint national committee jnc 8 are. The eighth joint national committee guidelines jnc 8 published in 2014 provides evidence based recommendations for management of hypertension and is an important reference for clinicians. Explore jnc 8 hypertension guidelines from jama network. In adults with hypertension, do various antihypertensive drugs or drug. While we were waiting for jnc 8, the american society of hypertension ash in collaboration with the international society of hypertension released their own expert opinion piece aimed at prescribers. The jnc 8 panel recommended a goal of 14090 mm hg for patients aged. Jama network open original investigation, march 8, 2019.
This study analyzed 61 prospective studies of one million americans aged 4089. High blood pressure stage i hypertension 140159 or 9099. Feb 26, 2018 jnc 8 guideline to management of hypertension 1. Hypertension is a common medical disease, occurring in about one third of young adults, almost two thirds of individuals over the age of 60, and in approximately 75% of individuals older than 70 years. While jnc 8 suggests treating patients with both diabetes and hypertension to a blood pressure goal pdf on jan 1, 2014, michael r page and others published the jnc 8 hypertension guidelines. Eighth joint national committee jnc8 guidelines and the.
In jnc 8, the initial drug choice is broadened to four classes. Problem magnitude 35 million office visits are as the primary diagnosis of htn. While jnc 8 suggests treating patients with both diabetes and hypertension to a blood pressure goal 14090 mmhg, ada standards of care advise treating to a goal of 14080 mmhg. The eighth joint national committee jnc 8 the new guideline has simpli. Because hypertension is largely managed with drug therapy, clinical. Jnc 8 recommends thresholds for treatment of high blood pressure, blood pressure goals, and evidencebased medication therapy.
Jnc8 guidelines for the management of hypertension in adults. The ada also states that a lower blood pressure goal of 80 mmhg may be reason. The guideline panel, however, suggested that patients 70 years with ckd or albuminuria should receive treatment based on comorbidity, frailty, and other patientspecific factors. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease. Antihypertensive drugs are organized around a clinical indicationthe need to treat a diseaserather than a receptor type. Pdf on jan 1, 2014, michael r page and others published the jnc 8 hypertension guidelines. Pharmacologypharmacy practice hypertension siyad a r hypertension 116, 4664, or high blood pressure, is a very common and. Jnc 8 hypertension guideline algorithm lifestyle changes. Hypertension htn is a prevalent disease state throughout the united states and is one of the risk factors for developing cardiovascular disease.
Antihypertensives are a class of drugs that are used to treat hypertension high blood pressure. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. Guidelines for management of high blood pressure in adults. Jan 21, 2014 compared with previous hypertension treatment guidelines, the joint national committee jnc 8 guidelines advise higher blood pressure goals and less use of several types of antihypertensive. Evidence suggests that reduction of the blood pressure by 5 mmhg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce. According to many patients and doctors in the early 1970s, this was considered normal. Aug 28, 2014 hypertension htn is a prevalent disease state throughout the united states and is one of the risk factors for developing cardiovascular disease.
Smoking cessation control blood glucose and lipids diet eat healthy i. Compared with previous hypertension treatment guidelines, the joint national committee jnc 8 guidelines advise higher blood pressure goals and less use of several types of antihypertensive. In 2001, hypertension was attributed to 92 million disabilityadjusted life years throughout the world. Jnc 8 guidelines were an evidencebased, focused set of rec. Antihypertensive effects of amlodipine and hydrochlorothiazide in elderly patients with ambulatory hypertension. Detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal jnc 8 are based on 27 large clinical trials concerning hypertension management. Although the nih ultimately withdrew from the guideline development process at a late stage in the development of jnc 8, the panel decided. Patients will be asking about the new jnc 8 hypertension guidelines, which were published in. Prevalence of hypertension, treatment, and blood pressure targets in canada associated with the 2017 american college of cardiology and american heart association blood pressure guidelines. Patients will be asking about the new jnc 8 hypertension guidelines.
Whats changed jnc uses randomized trial evidence, and is explicit when a recommendation reflects only expert opinion. Jnc 8 and more hypertension guidelines from the eighth joint national committee jnc 8 are finally here. While jnc 8 suggests treating patients with both diabetes and hypertension to a blood pressure goal hypertension management jnc 8 with picmonic for medicine with picmonic, facts become pictures. Jnc 8 guidelines for the management of hypertension practice guidelines 504. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Blood pressure thresholds and targets studies show that lowering blood pressure in adults with hypertension by 10 mm hg can reduce the risk of death from cardiovascular disease and stroke by 25% to 40%.