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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.
Key Concepts from the Eighth Joint National Committee (JNC 8) Guidelines
- 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.
- For adult patients less than 60 years old, a blood pressure goal of less than 140/90 mmHg is recommended.
- 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).
- 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)
- For African American patients, the guidelines recommend either a thiazide or calcium channel blocker as a first-line antihypertensive.
- Among patients with chronic kidney disease, an ACE inhibitor or an angiotensin receptor blocker (ARB) is recommended regardless of race or diabetic status.
- 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.
- 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)