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. Jnc8 guidelines for the management of hypertension in adults. Lifestyle recommendations should follow the recommendations of the lifestyle work group. Comparison of current recommendations with jnc 7 guidelines. Most people between 9 mmhg sbp or 8089 mmhg dbp will not require medication. Recommendations 1 through 5 address questions 1 and 2 concerning thresholds and goals for bp treatment. Dec 24, 20 in contrast, recommendations in jnc 8 mostly reflect randomized triallevel evidence, with explicit acknowledgement when a recommendation reflects only expert opinion. 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. Since then, all canadian hypertension guidelines have been based on a rigorous assessment of the evidence. Hypertension guidelines from the eighth joint national committee jnc 8 are finally here.
Chlorthalidone recommended over hctz, but preeminence as first line therapy might be challenged. In 2001, hypertension was attributed to 92 million disabilityadjusted life years throughout the world. 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. The following resource contains figures and tables from the 2017 accahaaapaabcacpm. Reduced role for betablockers as initial therapy still pre. Smoking cessation control blood glucose and lipids diet eat healthy i. Jun 01, 2015 hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure. Jnc 8 guidelines ease up on bp thresholds, drug choices. Total hypertension and uncontrolled hypertension in 20 years old.
Although this guideline provides evidencebased recommendations for the management of high bp and should. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pdf putting evidence based jnc 8 guideline into primary. Hypothetical jnc 8 recommendations goal bp likely to be refined relaxed for population subgroups, particularly for those 80 and those with dm.
Jnc 8 hypertension guideline algorithm initial drugs of. Report from the panel members appointed to the eighth joint national committee jnc 8. Introduction as many as 1 billion people worldwide suffer from hypertension. 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.
A canadian perspective on the eighth joint national committee. Initial combination therapy is recommended if bp is greater than. Chep follows a long tradition of evidencebased guidelines in canada starting with an evidencebased approach developed in 1975. 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. The previous guidelines jnc 7 was in 2003 and this focused. Pdf staying up to date with the jnc 8 hypertension guideline. Jaap 47 britain 2011, canada 20, europe 20, and the. Past htn guidelines jnc7 guidelines recommended five medication.
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. 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. Jnc 8 guidelines and stepwise approach to the treatment of. Both chep 20 and jnc 8 take an evidencebased approach to evaluating the literature supporting individual recommendations. Pharmacologic treatment should be initiated using one or more agents from 4 medication classes ace inhibitors, arbs, ccbs or thiazidetype diuretics. 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. These agents should be titrated to the target dose see table below. The division of the jnc8 drug treatment recommendations according to age. The eighth joint national committee jnc 8 recently released evidencebased recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults.
Jan 04, 2014 the division of the jnc8 drug treatment recommendations according to age. Explore jnc 8 hypertension guidelines from jama network. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd. Report from the panel members appointed to the eighth joint national committee jnc 8 jama. Begin 2 drugs at same time, as separate pills or combination pill.
Although final blood pressures systolicdiastolic were significantly lower in the stricttreatment group compared with the mildtreatment group 5. Reduced role for betablockers as initial therapy still pre eminent for hfref and cad, particularly atenolol. Jnc 8 guidelines for the management of hypertension in adults author. Jnc 8 provides nine recommendations for the manage. The eighth joint national committee jnc 8 the new guideline has simpli. 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. 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. 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. Newly created corridors shall comply with sections 1020.
Recommendation 9 is a summary of strategies based on expert opinion for starting and adding antihypertensive drugs. Hypertension, also known as high blood pressure, affects hundreds of millions of persons worldwide. Jnc 8 hypertension guideline algorithm lifestyle changes. Joint national committee 8 jnc 8 guidelines for management. Hypertension can lead to many complications, including myocardial. Jnc 8 guidelines for the management of hypertension in adults. In the united states alone, more than 65 million individuals have hypertension. Carrie armstrong, afp senior associate editor subject. Jnc 8 new guideline hypertension chart pharmacy exam. The previous guidelines jnc 7 was in 2003 and this focused on controlling elevated systolic blood pressure in all adults with. One of every 3 american adultsor approximately 67 million adults 31%has hypertension htn. Key points for practice in the general population, pharmacologic treatment should be initiated. Staying up to date with the jnc 8 hypertension guideline jaapa journal of the american academy of physician assistants. James pa, oparil s, carter bl, cushman wc, dennisonhimmelfarb c, handler j, et al.
Pdf on jan 1, 2014, michael r page and others published the jnc 8. The chart below summarizes recommendations based on the. Chlorthalidone 15,255 14,477,820,102 11,362 6,340 2,956 209. Recommendations 6, 7, and 8 address question 3 concerning selection of antihypertensive drugs. Start studying jnc 8 guidelines and stepwise approach to the treatment of htn. High blood pressure, if left untreated, can cause severe damage to the bodys organs. 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. Eighth joint national committee jnc8 guidelines and the. Year percent 20112012 20092010 20072008 20052006 20032004 20012002 19992000 19881994 0 10 20 30 40 50 60 70 80 90 source. A canadian perspective on the eighth joint national. Finally, the role of the jnc 8 panel recommendations remains less clear. High blood pressure, if left untreated, can cause severe damage to the bodys organs, including the brain, heart, blood. Whats good, whats missing, and why are most of the recommendations based on expert opinion. Recommendations 6, 7, 8 address question concerning selection of antihypertensive drugs.
Jnc 8 is very transparent about its guidelinewriting process, which aspired to the institute of medicines report on creation of trustworthy guidelines. Cdcnchs, national health and nutrition examination survey, 20. Weight loss helps to prevent hypertension range of approximate systolic bp reduction sbp, 520 mm hg per 10 kg. Hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure.
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