James pa, oparil s, carter bl, cushman wc, dennisonhimmelfarb c, handler j, et al. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd. The previous guidelines jnc 7 was in 2003 and this focused on controlling elevated systolic blood pressure in all adults with. The chart below summarizes recommendations based on the. Introduction as many as 1 billion people worldwide suffer from hypertension.
Recommendation 9 is a summary of strategies based on expert opinion for starting and adding antihypertensive drugs. Chep follows a long tradition of evidencebased guidelines in canada starting with an evidencebased approach developed in 1975. Staying up to date with the jnc 8 hypertension guideline jaapa journal of the american academy of physician assistants. Recommendations 6, 7, 8 address question concerning selection of antihypertensive drugs. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pdf on jan 1, 2014, michael r page and others published the jnc 8. Hypothetical jnc 8 recommendations goal bp likely to be refined relaxed for population subgroups, particularly for those 80 and those with dm. Recommendations 6, 7, and 8 address question 3 concerning selection of antihypertensive drugs. The eighth joint national committee jnc 8 recently released evidencebased recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults. Jnc 8 also backs away from the recommendation that thiazidetype diuretics should be initial therapy in most patients, suggesting an ace inhibitor, angiotensinreceptor blocker arb, calcium. Jnc 8 hypertension guideline algorithm lifestyle changes.
Hypertension, also known as high blood pressure, affects hundreds of millions of persons worldwide. Chlorthalidone 15,255 14,477,820,102 11,362 6,340 2,956 209. Finally, the role of the jnc 8 panel recommendations remains less clear. Jnc 8 guidelines ease up on bp thresholds, drug choices. Since then, all canadian hypertension guidelines have been based on a rigorous assessment of the evidence. Explore jnc 8 hypertension guidelines from jama network. The previous guidelines jnc 7 was in 2003 and this focused. Joint national committee 8 jnc 8 guidelines for management. Pdf staying up to date with the jnc 8 hypertension guideline. Pdf putting evidence based jnc 8 guideline into primary. Hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure. Hypertension guidelines from the eighth joint national committee jnc 8 are finally here.
Although final blood pressures systolicdiastolic were significantly lower in the stricttreatment group compared with the mildtreatment group 5. Total hypertension and uncontrolled hypertension in 20 years old. Most people between 9 mmhg sbp or 8089 mmhg dbp will not require medication. Past htn guidelines jnc7 guidelines recommended five medication. Jnc 8 guidelines for the management of hypertension in adults author. Jan 04, 2014 the division of the jnc8 drug treatment recommendations according to age. Pharmacologic treatment should be initiated using one or more agents from 4 medication classes ace inhibitors, arbs, ccbs or thiazidetype diuretics. Jnc 8 provides nine recommendations for the manage. Newly created corridors shall comply with sections 1020. Comparison of current recommendations with jnc 7 guidelines. The jnc 8 authors recommended against initiating antihypertensive therapy in patients over the age of 60 unless their blood pressure was over 15090 mm hg, which represents a loosening of the earlier recommendations to start drug treatment at the lower systolic level of 140 mm hg. Cdcnchs, national health and nutrition examination survey, 20. At the heart of the recommendations is the idea that being overly aggressive in bp management may cause more problems with side effects than you gain in stroke and heart attack prevention. Jan 21, 2014 the change to a more lenient systolic blood pressure goal may be confusing to many patients who are accustomed to the lower goals of jnc 7, including the jnc 8 also backs away from the recommendation that thiazidetype diuretics should be initial therapy in most patients, suggesting an ace inhibitor, angiotensinreceptor blocker arb, calcium.
New guidelines recommend that healthcare providers choose an initial drug class ace, arb, ccb, or thiazide diuretic based upon patient characteristics, such as age and concomitant chronic diseases. Recommendations 1 through 5 address questions 1 and 2 concerning thresholds and goals for bp treatment. A canadian perspective on the eighth joint national. The 2014 evidencebased guidelines for the management of high blood pressure in adults, was developed by panel members appointed to the eighth joint national committee jnc. Jnc 8 guidelines and stepwise approach to the treatment of. Initial combination therapy is recommended if bp is greater than. The eighth joint national committee jnc 8 the new guideline has simpli. Weight loss helps to prevent hypertension range of approximate systolic bp reduction sbp, 520 mm hg per 10 kg. Jnc 8 new guideline hypertension chart pharmacy exam. Updated hypertension recommendations from panel members previously appointed to the eight joint national committee jnc 8 raised blood pressure goals in adults age 60 and older to less than 15090 mm hg, with patients younger than 60 years old including those with chronic kidney disease and diabetes having a target of less than 14090 mm hg. Jun 01, 2015 hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure.
Key points for practice in the general population, pharmacologic treatment should be initiated. Year percent 20112012 20092010 20072008 20052006 20032004 20012002 19992000 19881994 0 10 20 30 40 50 60 70 80 90 source. Reduced role for betablockers as initial therapy still pre. Reduced role for betablockers as initial therapy still pre eminent for hfref and cad, particularly atenolol. Smoking cessation control blood glucose and lipids diet eat healthy i. The change to a more lenient systolic blood pressure goal may be confusing to many patients who are accustomed to the lower goals of jnc 7. Hypertension can lead to many complications, including myocardial. Report from the panel members appointed to the eighth joint national committee jnc 8 jama.
Report from the panel members appointed to the eighth joint national committee jnc 8. In subsequent years, a series of joint national committee jnc bp guidelines were published to assist the practice community and improve prevention, awareness, treatment, and control of high bp. One of every 3 american adultsor approximately 67 million adults 31%has hypertension htn. The division of the jnc8 drug treatment recommendations according to age.
Although this guideline provides evidencebased recommendations for the management of high bp and should. Dec 24, 20 in contrast, recommendations in jnc 8 mostly reflect randomized triallevel evidence, with explicit acknowledgement when a recommendation reflects only expert opinion. Carrie armstrong, afp senior associate editor subject. A canadian perspective on the eighth joint national committee. 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 reallife practice settings.
Jnc 8 hypertension guideline algorithm initial drugs of. Jaap 47 britain 2011, canada 20, europe 20, and the. Begin 2 drugs at same time, as separate pills or combination pill. In 2001, hypertension was attributed to 92 million disabilityadjusted life years throughout the world. These agents should be titrated to the target dose see table below.
Jnc8 guidelines for the management of hypertension in adults. Lifestyle recommendations should follow the recommendations of the lifestyle work group. Start studying jnc 8 guidelines and stepwise approach to the treatment of htn. Chlorthalidone recommended over hctz, but preeminence as first line therapy might be challenged. High blood pressure, if left untreated, can cause severe damage to the bodys organs. 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. Whats good, whats missing, and why are most of the recommendations based on expert opinion.
High blood pressure, if left untreated, can cause severe damage to the bodys organs, including the brain, heart, blood. Both chep 20 and jnc 8 take an evidencebased approach to evaluating the literature supporting individual recommendations. Eighth joint national committee jnc8 guidelines and the. The 2014 evidencebased guidelines for the management of high blood pressure in adults, was developed by panel members appointed to the eighth joint national committee jnc 8 and was endorsed by. Jnc 8 guidelines for the management of hypertension in adults. Lifestyle recommendations were also published in 20. There have been controversial discussions regarding the most evidencebased blood pressure management guidelines after the release of the eighth joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 8 guidelines. The following resource contains figures and tables from the 2017 accahaaapaabcacpm. 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. Jnc 8 is very transparent about its guidelinewriting process, which aspired to the institute of medicines report on creation of trustworthy guidelines.
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