New JNC 8 Hypertension Guidelines: What Does the Panel Recommend Now?

The Eighth Joint National Committee (JNC 8) has released new guidelines on the management of adult hypertension.

The authors formed nine recommendations which are discussed in detail along with the supporting evidence. Evidence was taken from randomized controlled trials, the gold standard for establishing efficacy and effectiveness. Some of the new major recommendations include:

1. In patients aged ≥60 years, initiate pharmacologic treatment in systolic BP ≥150mmHg or diastolic BP ≥90mmHg and treat to a goal systolic BP <150mmHg and goal diastolic BP <90mmHg. (Strong Recommendation–Grade A)

2. In patients aged <60 years, initiate pharmacologic treatment at diastolic BP ≥90mmHg and treat to a goal <90mmHg. (For ages 30–59 years, Strong Recommendation–Grade A; For ages 18–29 years, Expert Opinion–Grade E)

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3. In patients aged <60 years, initiate pharmacologic treatment at systolic BP ≥140mmHg and treat to a goal <140mmHg. (Expert Opinion–Grade E)

4. In patients aged ≥18 years with chronic kidney disease, initiate pharmacologic treatment at systolic BP ≥140mmHg or diastolic BP ≥90mmHg and treat to goal systolic BP <140mmHg and goal diastolic BP <90mmHg. (Expert Opinion–Grade E)

5. In patients aged ≥18 years with diabetes, initiate pharmacologic treatment at systolic BP ≥140mmHg or diastolic BP ≥90mmHg and treat to a goal systolic BP <140mmHg and goal diastolic BP <90mmHg. (Expert Opinion–Grade E)

6. In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, CCB, ACE inhibitor, or ARB. (Moderate Recommendation–Grade B) This recommendation is different from the JNC 7 in which the panel recommended thiazide-type diuretics as initial therapy for most patients.

7. In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation–Grade C)

8. In the population aged ≥18 years with chronic kidney disease, initial (or add-on) antihypertensive treatment should include an ACE inhibitor or ARB to improve kidney outcomes. (Moderate Recommendation–Grade B)

9. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in Recommendation 6. If goal BP cannot be reached with two drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in Recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. (Expert Opinion–Grade E)

The full guidelines have been published online at JAMA.

For more information call (800) 262-2350 or visit JAMAnetwork.com.

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