Guidelines Ease Up on BP Thresholds, Drug Choices

CHICAGO, IL — At long last, the Eighth Joint National Committee (JNC 8) has released its new guidelines on the management of adult hypertension, which contain two key departures from JNC 7 that the authors say will simplify careheartwire .

"We wanted to make the message very simple for physicians: treat to 150/90 mm Hg in patients over age 60 and 140/90 for everybody else. And we simplified the drug regimen as well, to say that any of these [four] choices are good, just get people to goal. Monitor them, track them, remonitor them. That's a very simple message."

Nine Recommendations

Those questions then form the basis for nine recommendations, discussed in depth and assigned a score for both the strength of the recommendation and the evidence supporting it. Among the recommendations:
  • In patients 60 years or over, start treatment in blood pressures >150 mm Hg systolic or >90 mm Hg diastolic and treat to under those thresholds.
  • In patients <60 years, treatment initiation and goals should be 140/90 mm Hg, the same threshold used in patients >18 years with either chronic kidney disease (CKD) or diabetes.
  • In nonblack patients with hypertension, initial treatment can be a thiazide-type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide-type diuretic or CCB.
  • In patients >18 years with CKD, initial or add-on therapy should be an ACE inhibitor or ARB, regardless of race or diabetes status.


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