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Disease in Women
A Review of the JNC 8
Blood Pressure Guideline
H
Eduardo Hernandez-Vila, ypertension is a major independent risk factor for coronary artery disease,
MD stroke, heart failure, and renal failure. One of every 3 American adultsor
approximately 67 million adults (31%)has hypertension (HTN).1 A person
over the age of 55 years has a 90% lifetime risk of developing HTN.2 Hypertension
accounts for 18% of cardiovascular disease deaths in Western countries.3 High blood
pressure (BP) costs the nation $47.5 billion each year.4
In 2014, the Eighth Joint National Committee (JNC 8) published the evidence-
based guideline for the 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.5
Presented at the 5th Annual In adults with HTN, does initiating antihypertensive pharmacologic therapy at
Symposium on Risk,
Diagnosis and Treatment of
specific BP thresholds improve health outcomes?
Cardiovascular Disease in In adults with HTN, do attempts to reach specified BP goals with antihyperten
Women; Houston, sive pharmacologic therapy lead to improvements in health outcomes?
12 December 2014.
In adults with HTN, do various antihypertensive drugs or drug classes differ in
regard to specific health outcomes?5
Section Editor:
Stephanie A. Coulter, MD
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
Key words: Antihyperten- to make the recommendation: grade A is indicative of strong evidence, grade B of
sive agents/therapeutic use;
blood pressure/drug effects;
moderate evidence, grade C of weak evidence, and grade E of expert opinion (in lieu
chronic kidney disease; of sufficient evidence). Below are the 9 recommendations.5
diabetes mellitus; evidence-
based medicine; hyperten-
sion/drug therapy/prevention
Recommendation 1. The guideline recommends the initiation of drug therapy in
& control; hypertension, dia- order to lower a systolic BP (SBP) of 150 mmHg or a diastolic BP (DBP) of 90
stolic; hypertension, systolic; mmHg for the general population at 60 years of age or older (Grade A). A corol
practice guidelines as topic /
standards
lary recommendation is that patients whose achieved SBP on pharmacologic therapy
is lower than the new guideline recommendation can be continued at that level of
therapy, if well tolerated (Grade E).
From: Diagnostic Heart
Center, CHI St. Lukes
Recommendation 2. The target DBP to start pharmacologic therapy for subjects
HealthBaylor St. Lukes younger than 60 years of age is 90 mmHg. On the basis of available evidence, the
Medical Center, Houston, recommendation for patients aged 30 to 59 years is strong (Grade A). For those be
Texas 77030
tween the ages of 18 and 29, the recommendation is on the basis of expert opinion
(Grade E).
Address for reprints: Recommendation 3. The target SBP to start pharmacologic therapy for subjects
Eduardo Hernandez-Vila,
MD, Department of Cardiol-
younger than 60 years of age is 140 mmHg (Grade E).
ogy, CHI St. Lukes Health Recommendation 4. In the population aged 18 years or older with chronic kidney
Baylor St. Lukes Medical disease, initiate pharmacologic treatment to lower BP at SBP 140 mmHg or DBP
Center, 6624 Fannin St.,
Suite 2780, Houston, TX
90 mmHg and treat to a goal of SBP <140mmHg and a goal of DBP <90 mmHg
77030 (Grade E).
Recommendation 5. The target blood pressure in beginning pharmacologic therapy
E-mail:
for the diabetic population aged 18 years or older is <140 mmHg for SBP and <90
eduardohernandezmd@ mmHg DBP (Grade E).
gmail.com Recommendation 6. Initial drug therapy for nonblack patients (including diabetic
patients) should include a thiazide-type diuretic, a calcium channel blocker, an angio
2015 by the Texas Heart tensin-converting enzyme (ACE) inhibitor, or an angiotensin receptor blocker (Grade
Institute, Houston B).
Texas Heart Institute Journal Review of JNC 8 Blood Pressure Guideline 227
11. JATOS Study Group. Principal results of the Japanese trial to
assess optimal systolic blood pressure in elderly hypertensive
patients (JATOS). Hypertens Res 2008;31(12):2115-27.
12. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A,
Bohm M, et al. 2013 ESH/ESC guidelines for the manage
ment of arterial hypertension: the task force for the man
agement of arterial hypertension of the European Society of
Hypertension (ESH) and of the European Society of Cardiol
ogy (ESC). J Hypertens 2013;31(7):1281-357.
228 Review of JNC 8 Blood Pressure Guideline Volume 42, Number 3, 2015