The New JNC 8 Hypertension Guidelines

Hypertension guidelines refer to the important criteria that qualified physicians and health care providers are supposed to use for the diagnosing and treatment of high blood pressure or hypertension.

 They are generally evidence based guideline, relying on extensive research, studies and clinical trials

 The specific guidelines being discussed on this page refers to the newly released, Eighth Joint National  Committee (JNC 8) for the Management of High blood pressure in adults, in the United States of America.

This new release was published in December 2013 in Journal of the American Medical Association (JAMA)

The last report before this latest one was released in 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure  (JNC 7).

Even though, the hypertension guidelines are for the physicians and health care professionals each one of us, should have a basic idea of what these guidelines are.

   Three Main Questions Guiding the Evidence Review

1)  In adults with hypertension, does initiating anti-hypertensive pharmacologic therapy at specific BP thresholds improve health outcomes ?

2)  In adults with hypertension, does treatment with anti-hypertensive pharmacologic therapy to a specific BP goal lead to improvement in health outcomes ?

3)  In adults with hypertension, do various anti-hypertensive drugs or drug classes differ in comparative  benefits and harms on specific health outcomes ?

Here are 2 out of 9 of the New Recommendations

""Recommendations for Management of Hypertension

Recommendation 1

In the general population aged 60 years or over, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) 150 mm Hg or over or diastolic blood pressure (DBP) 90 mm Hg or over and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A)

Corollary Recommendation

In the general population aged 60 years or over, if pharmacologic treatment for high BP results in lower achieved SBP (e.g. <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)

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)""

Source : 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults......JAMA  Dec 18,2013

One of the major changes in the JNC 8 was the guideline, about when to start the treatment for healthy adult over the age of 60.....This was their #1  out of other Hypertension Guidelines released. This specific guideline dealt with specific Blood Pressure Goal for people over the age of 60.

 With this new hypertension guideline, fewer healthy adults over the age of 60  with high blood pressure, may end up having no medication or fewer medications prescribed by their physicians.

It was suggested, for the treatment to start, when the blood pressure is over 150/90....and the goal is to bring the systolic blood pressure to lower than 150......  10 points higher than the 140/90 mmHg from the previous guideline (JNC 7)

As stated earlier, Hypertension Guidelines are generally for the medical doctors and health care providers but it is a good idea for every one of us to have a basic information of what it is and how it may affect our individual treatment or management.

Hypertension Treatment Algorithm

If you are directly affected by the new hypertension guideline, please have a constructive conversation with your physician and decide, your best course of action(s)

Please keep in mind, this Hypertension Guidelines are just recommendations. Physician and patient / client alike, still has to agree on what is best and unique to every individual, and hopefully support and maintain this individuals well-being and keep the blood pressure under control.