Jnc 7 vs jnc-8

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Recommendation 1

In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150><90><140><60><90><60><140><140><90><140><90 mm Hg. (Expert Opinion – Grade E)

Recommendation 6

In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)

Recommendation 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)

Recommendation 8

In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)

Recommendation 9

The main objective of hypertension treatment is to attain and maintain goal BP. 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 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 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. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)

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Jnc 7 vs jnc-8

  1. 1. JNC 8 vs. JNC 7 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
  2. 2. All time human experience Hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure
  3. 3. Eighth Joint National Committee (JNC 8),2014 Management of high BP in adults.This new guideline was characterized by a systematic review of the literature with an emphasis on randomized, controlled clinical trials. The guideline attempted to answer 3 key questions 1. In adults with HTN, does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? 2. In adults with HTN, do attempts to reach specified BP goals with antihypertensive pharmacologic therapy lead to improvements in health outcomes? 3. In adults with HTN, do various antihypertensive drugs or drug classes differ in regard to specific health outcomes?
  4. 4. 9 Recommendations and 3 Key questions The committee provided 9 graded recommendations to answer the 3 key questions. Grading was performed on the basis of the strength of the available evidence used to make the recommendation: grade A is indicative of strong evidence, grade B of moderate evidence, grade C of weak evidence, and grade E of expert opinion (in lieu of sufficient evidence).
  5. 5. JNC 8:Recommendations for Management of Hypertension Recommendations 1 through 5:Thresholds and goals for BP treatment Recommendations 6, 7, and 8 :Selection of antihypertensive drugs Recommendation 9 :Starting and adding antihypertensive drugs
  6. 6. R 1  In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A)  Corollary In the general population aged ≥60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E)
  7. 7. R2 In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP ≥90 mm Hg and treat to a goal DBP <90 mm Hg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18- 29 years, Expert Opinion – Grade E)
  8. 8. R3:ISH In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg and treat to a goal SBP <140 mm Hg. (Expert Opinion – Grade E)
  9. 9. R4:TARGET In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)
  10. 10. R5:18+ DM In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to a goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)
  11. 11. R6:WHICH ONE START WITH In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)
  12. 12. R7:INITIAL IS THIAZIDE 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)
  13. 13. R8:CKD In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)
  14. 14. R9:ADD ONE AT A TIME Attain and maintain goal BP  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 (thiazide-type diuretic, CCB, ACEI, or ARB Assess BP and adjust the treatment regimen until goal BP is reached  If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided  Do not use an ACEI and an ARB together  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  Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)

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