The JNC-8 Guidelines: A Clinical Review
Hypertension remains a significant cause of mortality and morbidity in the United States and is seen routinely in the primary care setting. Family physicians are frequently encountering individuals with hypertension and are primarily responsible for the initial diagnosis and initiation of treatment. The last review of this condition with a summary of definitions and recommendations for both diagnostic criteria and treatment came in the form of the guideline by Seventh Joint National Committee on the management of hypertension (JNC 7) in 2003. In the last decade research has placed direct questioning of the recommendations put forth in that document. Now the Eighth Joint National Commission (JNC 8) review has been made available with changes in diagnostic criteria and treatment options.
Three questions guiding the most recent review of literature were put forth. 1) Does initiating treatment at a particular threshold improve outcomes, 2) Does treatment to a particular systolic or diastolic goal improve outcomes, and 3) Do the various classes of medication confer different benefits and harms relative to specific outcomes. Key changes from JNC 7 include an increase in the systolic threshold to 150mmHg prior to initiation of pharmacologic treatment in those aged 60 and older and specific pharmacologic options based on racial differences and the presence of diabetes and/or chronic kidney disease.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.
Powers B, Greene L, Balfe LM. Updates on the treatment of essential hypertension: A summary of AHRQ's comparative effectiveness review of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and direct renin inhibitors. J Manag Care Pharm. 2011;17(8 Suppl):S1-14.
Gillespie CD, Hurvitz KA, Centers for Disease Control and Prevention (CDC). Prevalence of hypertension and controlled hypertension - united states, 2007-2010. MMWR Surveill Summ. 2013;62 Suppl 3:144-148.
Heart disease and stroke." - healthy people 2020. N. p., 2 dec 2010.
Health, United States, 2013 In: Hyattsville (MD): National Center for Health Statistics (US); 2014 May:Table 64.
Brown M. Hypertension and ethnic group. BMJ. 2006;332(7545):833-6.
Ogihara T, Saruta T, Matsuoka H, et al. Valsartan in elderly isolated systolic hypertension (VALISH) study: Rationale and design. Hypertens Res. 2004;27(9):657-661.
Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: Valsartan in elderly isolated systolic hypertension study. Hypertension. 2010;56(2):196-202.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. final results of the systolic hypertension in the elderly program (SHEP). SHEP cooperative research group. JAMA. 1991;265(24):3255-3264.
Armario P, de la Sierra A. Blood pressure as a therapeutic target in stroke. Curr Top Med Chem. 2009;9(14):1278-1284.
Five-year findings of the hypertension detection and follow-up program. I. reduction in mortality of persons with high blood pressure, including mild hypertension. hypertension detection and follow-up program cooperative group. 1979. JAMA. 1997;277(2):157-166.
Five-year findings of the hypertension detection and follow-up program. III. reduction in stroke incidence among persons with high blood pressure. hypertension detection and follow-up program cooperative group. JAMA. 1982;247(5):633-638.
Five-year findings of the hypertension detection and follow-up program. I. reduction in mortality of persons with high blood pressure, including mild hypertension. hypertension detection and follow-up program cooperative group. JAMA. 1979;242(23):2562-2571.
Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. systolic hypertension in the elderly program cooperative research group. JAMA. 1996;276(23):1886-1892.
Wright JT,Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: Results from the AASK trial. JAMA. 2002;288(19):2421-2431.
Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocr Pract. 2013;19(2):327-336.
Page MR. The JNC 8 hypertension guidelines: An in-depth guide. American Journal of Managed Care. 2014(Jan-Feb).
Bangalore S, Steg G, Deedwania P, et al. Beta-blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308(13):1340-1349.
Dahlof B, Devereaux R, Kjeldsen S. Cardiovascular morbidity and mortality in the losartan intervention for endpoint reduction in hypertension studey (LIFE): A randomised trial against atenolol. Lancet. 2002;359(9311):995-1003.
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy: Final results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Hypertension. 2003;42(3):239-246.
Muntner P, Levitan EB, Lynch AI, et al. Effect of chlorthalidone, amlodipine, and lisinopril on visit-to-visit variability of blood pressure: Results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial. J Clin Hypertens (Greenwich). 2014.