HelixTalk Episode #2 - Antihypertension Guidelines (JNC 8 and more)

Date posted: April 22, 2014, 6:00 am

In this episode, we discuss the new JNC 8 guidelines and how these guidelines differ from other hypertension guidelines released in 2013-2014.

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Key Concepts from the Eighth Joint National Committee (JNC 8) Guidelines

1. For most elderly patients (aged 60 years or older), a blood pressure goal of less than 150/90 mmHg is recommended.  For elderly patients at high risk (ie, African Americans, history of ASCVD, multiple cardiovascular risk factors), a lower goal of less than 140/90 mmHg should be considered.
2. For adult patients less than 60 years old, a blood pressure goal of less than 140/90 mmHg is recommended.
3. In patients with diabetes or chronic kidney disease (CKD), a blood pressure goal of less than 140/90 mmHg is recommended.  Both of these groups have historically had different blood pressure goals from a variety of different guidelines (such as the American Diabetes Association).
4. For non-African American patients, the guidelines recommend the following as first-line antihypertensives: thiazide diuretics (such as chlorthalidone), calcium channel blockers (such as amlodipine), ACE inhibitors (such as lisinopril), or angiotensin receptor blockers (ARBs, such as losartan)
5. For African American patients, the guidelines recommend either a thiazide or calcium channel blocker as a first-line antihypertensive.
6. Among patients with chronic kidney disease, an ACE inhibitor or an angiotensin receptor blocker (ARB) is recommended regardless of race or diabetic status.
7. If blood pressure goal is not reached after 1 month of therapy, the guidelines have no preference between increasing the first antihypertensive to a maximum dose OR adding a second antihypertensive before increasing the dose of the first antihypertensive.
8. There are several other guidelines that have discrepant recommendations from JNC 8 with regard to blood pressure goals and first-line therapies.  Two examples of other guidelines include the 2013 American Society of Hypertension (ASH)/International Society of Hypertension (ISH) guidelines and the 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines

For more information, click here for the JNC 8 Guidelines (full text)