The document compares the 2013 European Society of Cardiology (ESC) hypertension guidelines to the 2014 Eighth Joint National Committee (JNC 8) guidelines. Some key differences include: ESC defines pre-hypertension while JNC 8 does not, ESC recommends lifestyle changes for pre-hypertension while JNC 8 does not, and ESC recommends beta-blockers as first-line treatment while JNC 8 recommends thiazide diuretics, ACE inhibitors, ARBs, or CCBs as first-line based on clinical trials. Both guidelines relax blood pressure targets for elderly patients over 60 or 80 years old, respectively.

1. JNC 8 2014 V/S ESC 2013
HYPERTENSION GUIDELINESOVERVIEW
DR SUHAIL, KIMS,TRIVANDRUM

2. SALIENT FEATURES
ESC
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•
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•
•
JNC8
Importance of ABPM/HBPM. •
White coat htn/ masked htn. •
Target goal ˂ 140/90 mm hg. •
Relaxation of target BP in
•
elderly. (>80 YRS)
No intervention in high
•
normal (pre htn) BP.
BB as first line drug.
•
Position of diuretics- first
•
line
Search for asymptomatic OD •
Special population
stratifications
DEFINITION = JNC7
NO GRADING OF HTN
TARGET GOAL<140/90
RELAXATION OF BP IN
ELDERLY (>60 YRS)
NO pre HTN group
BB degraded as fourth line
Diuretic retained as first line
& FIRST
NO COMMENTS ON SPECIAL
POPULATIONINDIVIDUALISED
TREATMENTS!.

3. ESC – Class of evidences

4. JNC8

5. ESC- Definitions and classification of office blood
pressure levels (mmHg)

6. JNC8

7. Stratification of total CV risk in categories of low, moderate, high and very high risk according
to SBP and DBP and prevalence of RFs, asymptomatic OD, diabetes, CKD stage or
symptomatic CVD. Subjects with a high normal office but a raised out-of-office BP (masked
hypertension) have a CV risk in the hypertension range.
ESC
Authors/Task Force Members et al. Eur Heart J
2013;eurheartj.eht151
© The European Society of Hypertension (ESH) and European Society of Cardiology (ESC)
2013. All rights reserved. For permissions please email: journals.permissions@oup.com.

8. Comparison with JNC 7
Contd…

9. ESC
Initiation of lifestyle changes and antihypertensive drug treatment.
Authors/Task Force Members et al. Eur Heart J
2013;eurheartj.eht151
© The European Society of Hypertension (ESH) and European Society of Cardiology (ESC)
2013. All rights reserved. For permissions please email: journals.permissions@oup.com.

10. JNC8

12. ESC
Initiation of antihypertensive drug treatment

14. when weighing the risks and benefits of a lower BP
goal for people aged 70 years or older with
estimated GFR less than 60 mL/min/
1.73m , antihypertensive treatment should be
individualized, taking into consideration factors
such as frailty, comorbidities, and albuminuria
2

15. Blood pressure goals in hypertensive patients

16. Initiation of antihypertensive treatment at a DBP
threshold of 90 mmHg or higher.
Treatment to a DBP goal of lower than90mm Hg
reduces cerebrovascular events, heart failure, and
overall mortality.
there is no benefit in treating patients to a goal
of either 80mmHg or lower or 85mmHg or lower
compared with90mmHg or lower.

17. ESC
BETA BLOCKERS
• Though Cochrane meta-analysis has reported
that beta-blockers may be inferior to some—but
not all—other drug classes for some outcomes;
• the large meta-analysis by Law et al. has shown
beta-blocker-initiated therapy to be equally as
effective as the other major classes of
antihypertensive agents in preventing coronary
outcomes and
• highly effective in preventing CV events in
patients with a recent myocardial infarction and
those with heart failure.

18. JNC8
The panel did not recommend βblockers for the initial treatment of
hypertension because in one study use of βblockers resulted in a higher rate of the primary
composite outcome of cardiovascular
death,myocardial infarction, or stroke compared to
use of an ARB, a finding that was driven largely by
an increase in stroke.
In the other studies that compared a β-blocker to
the 4 recommended drug classes, the β-blocker
performed similarly to the other drugs or the
evidence was insufficient to make a determination

19. ESC
Drugs to be preferred in specific conditions

20. JNC8
any of these 4 classes would be good choices as addon agents .
this recommendation is specific for thiazide-type
diuretics, which include thiazide
diuretics, chlorthalidone, and indapamide; it does not
include loop or potassium- sparing diuretics.
it is important that medications be dosed adequately to
achieve results similar to those seen in the RCTs.
RCTs that were limited to specific non hypertensive
populations, such as those with coronary artery disease
or heart failure,were not reviewed for this
recommendation.
Therefore, recommendation should be applied with
caution to these populations.

21. ESC

22. JN
C8
Strategies to Dose Antihypertensive Drugs

23. JNC8

24. SPECIAL POPULATIONS

25. any of these 4 classes would be good choices as addon agents .
this recommendation is specific for thiazide-type
diuretics, which include thiazide
diuretics, chlorthalidone, and indapamide; it does not
include loop or potassium- sparing diuretics.
it is important that medications be dosed adequately to
achieve results similar to those seen in the RCTs.
RCTs that were limited to specific non hypertensive
populations, such as those with coronary artery disease
or heart failure,were not reviewed for this
recommendation.
Therefore, recommendation should be applied with
caution to these populations.

26. Treatment strategies in white-coat and masked
hypertension

27. Antihypertensive treatment strategies in the elderly

28. Treatment strategies in hypertensive women

29. Treatment strategies in patients with diabetes

30. JNC & ESC
• NO PRE HTN
• LIBERAL IN ELDERLY
ACEI, ARB & CCB- FIRST LINE

31. Treatment strategies in hypertensive patients with
metabolic syndrome

32. Therapeutic strategies in hypertensive patients with
nephropathy

33. Therapeutic strategies in hypertensive patients with
cerebrovascular disease

34. Therapeutic strategies in hypertensive patients with
heart disease

35. Therapeutic strategies in hypertensive patients with
atherosclerosis, arteriosclerosis, and peripheral artery
disease

36. Therapeutic strategies in patients with resistant
hypertension

37. Treatment of risk factors associated with hypertension