Article

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).

JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 12/2013; 311(5). DOI: 10.1001/jama.2013.284427
Source: PubMed

ABSTRACT Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, 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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    • "Even a small reduction in the mean blood pressure of a population can lead to a decrease in cardiovascular morbidity and mortality [14]. Therefore, for prevention and management of hypertension, the American Heart, Lung and Blood Institute recommends adherence to the DASH (Dietary Approaches to Stop Hypertension) dietda diet based on low intake of sodium and fat, and high intake of fruits and vegetables [12] [14]. The European Society of Hypertension also recommends a decrease in the intake of sodium and fat, and an increase in the consumption of vegetables and fruits to lower blood pressure levels [15]. "
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    • "In our study, participants who attended a screening visit were more likely to have subsequent claims for hypertension, diabetes and dyslipidemia in the following year, confirming that increased detection of CVD-related health conditions lead to subsequent care (James et al., 2014; Lackland et al., 2014). Similar results have been found in a cohort study in Taiwan (Lin et al., 2011). "
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    • "The choice of antihypertensive treatment, particularly for the firstline agent, should be made with caution as it could significantly affect clinical outcomes [13]. Existing guidelines, including those of the National Institute for Health and Clinical Excellence (NICE), the updated Eighth Joint National Committee (JNC 8th), and the reappraisal of the European hypertension guidelines in 2008 all recommended angiotensinconverting-enzyme (ACE) inhibitors as one of the preferred first-line agent for management of arterial hypertension [14] [15] [16] [17]. Nevertheless, there have not been explicit recommendations on which ACE inhibitor is more preferred. "
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