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2014 evidence-based guidelines for the management of high blood pressure in adults

Report from the panel members appointed to the Eighth Joint National Committee ( JNC 8 ). 2014 evidence-based guidelines for the management of high blood pressure in adults.

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2014 evidence-based guidelines for the management of high blood pressure in adults

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  1. Report from the panel members appointed to the EighthJoint National Committee (JNC 8) 2014 evidence-based guidelinesfor the managementof high blood pressure in adults Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; William C. Cushman, MD; Cheryl Dennison-Himmelfarb, RN, ANP, PhD; Joel Handler, MD; Daniel T. Lackland, DrPH; Michael L. LeFevre, MD, MSPH; Thomas D. MacKenzie, MD, MSPH; OlugbengaOgedegbe, MD, MPH, MS; Sidney C. Smith Jr, MD; Laura P. Svetkey, MD, MHS; Sandra J. Taler, MD; Raymond R. Townsend, MD; Jackson T. Wright Jr, MD, PhD; Andrew S. Narva, MD; Eduardo Ortiz, MD, MPH JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.

  2. Questions guiding the JNC8 review This hypertension guideline focuses on 3 questions related to high blood pressure (BP) management. They address thresholds, goals for pharmacologic treatment, and whether particular antihypertensive drugs or drug classes improve important health outcomes compared to others. • In adults with hypertension, does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? • In adults with hypertension, does treatment with antihypertensive pharmacologic therapy to aspecified BP goallead to improvements in health outcomes? • In adults with hypertension, do various antihypertensive drugs or drug classes differin comparative benefits and harms on specific health outcomes?  The answers to these three questions are reflected in 9 recommendations JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.

  3. Recommendations (1/3) BP thresholds Goals • Recommendation 1 (Strong recommendation) • Recommendation 2 (Strong recommendation) • Recommendation 3 (Expert opinion) General population ≥60 years SBP ≥150 mm Hg or DBP ≥90 mm Hg SBP <150 mm Hg and DBP <90 mm Hg General population <60 years DBP <90 mm Hg DBP ≥90 mm Hg General population <60 years SBP ≥140 mm Hg SBP <140 mm Hg JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.

  4. Recommendations (2/3) BP thresholds Goals • Recommendation 4 (Expert opinion) • Recommendation 5 (Expert opinion) • Recommendation 6 (Moderate recommendation) Population withCKD≥18 years SBP ≥140 mm Hg or DBP ≥90 mm Hg SBP <140 mm Hg and DBP <90 mm Hg CKD: chronic kidney disease Population withdiabetes≥18 years SBP ≥140 mm Hg or DBP ≥90 mm Hg SBP <140 mm Hg and DBP <90 mm Hg Initial treatment Thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) General nonblack population (with diabetes) JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.

  5. Recommendations (3/3) Initial treatments • Recommendation7 (Moderate recommendation) • Recommendation8 (Moderate recommendation) • Recommendation9 (Expert opinion) General (with diabetes) black population Thiazide-type diuretic, or calcium channel blocker (CCB) Initial or add-on treatments Angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) Population with CKD≥18 years Non control strategies Goal BP not reached within a month of treatment Increase the dose of the initial drug, or add a second drug (from the list provided) Goal BP not 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 JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.

  6. Conclusions • This JNC8 guideline has not redefined high BP, and considers the 140/90 mm Hg definition from JNC 7 reasonable. • It offers clinicians an analysis of what is known and not known about BP treatment thresholds, goals, and drug treatment strategies to achieve those goals. • However these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

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