The JNC-8 Guidelines: A Clinical Review
Abstract
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.
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Accepted 2014-12-08
Published 2015-01-05
