Patients will be asking about the new JNC 8 hypertension guidelines, which were published in the Journal of the American Medical Association on December 18, 2013.1. Since the publication of the JNC 6 report, the NHBPEP Coordinating Committee, chaired by the director of the NHLBI, has regularly reviewed and discussed studies on hypertension. University of Texas Southwestern Medical School at Dallas Dallas, TX, Elijah Saunders, M.D., F.A.C.C., F.A.C.P. Home | Hypertension and High Blood Pressure | JAMA Network Miami, FL, Jay Merchant, M.H.A. Boston University School of Medicine University of Colorado Health Sciences Center (Revised May 2003). Does This Child With High Blood Pressure Have Secondary Hypertension? Changes between the 2022 and 2015/2017 Taiwan Hypertension Guidelines, new recommendations, and the "not to do" list are summarized in Tables 1A . Dr. Manger has served as a consultant/advisor for the NHBPEP Coordinating Committee. Procter and Gamble Thereafter, the NHBPEP Coordinating Committee chair appointed the JNC 7 chair and an Executive Committee derived from the Coordinating Committee membership. Bethesda, MD, Mark E. Dunlap, M.D. The most hotly debated recommendation is one to loosen the blood pressure goal for healthy patients from 140/90 mm Hg to 150/90 mm Hg starting at age 60. In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age. Medication formulary policies represent a key determinant of access to medication and can be leveraged to advance pharmacoequity and health equity writ large. Crossref Medline Google Scholar; 11. Key Points for Practice. All Rights Reserved. Recently Published Hypertension Guidelines of the JNC 8 Panelists, the This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. CHICAGO, IL At long last, the Eighth Joint National Committee (JNC 8) has released its new . A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. These outcomes are strongly affected by nonfatal stroke, HF, CHD, and renal disease; hence, these outcomes were considered along with mortality in the committee's evidencebased deliberations. JAMA. Public health approaches (e.g. Most patients will require two or more antihypertensive drugs to achieve goal BP. doi:10.1001/jama.2013.284427. Explore guidelines, recommendations, articles, and resources on the epidemiology, diagnosis, and management of high blood pressure, including the 2014 JNC8 guideline, the 2017 Hypertension Guideline from ACC and AHA, the 2018 Guidline from ESC and ESH, and the 2021 USPSTF Recommendation: Screening for Hypertension in Adults. Awake, individuals with hypertension have an average BP of >135/85 mmHg and during sleep >120/75 mmHg. An official website of the United States government. Veterans Affairs Medical Center Rush University Medical Center evidence-based guideline for the management of high blood pressure in adults. American Nurses Association Dr. Chobanian has received honoraria for serving as a speaker from Monarch, Wyeth, Astra- Zeneca, Solvay, and Bristol-Myers Squibb. New Orleans, LA, Haralambos Gavras, M.D. Other risk factors should be managed aggressively. Veterans Affairs Medical Center, Memphis, TN, Lee A. PDF The Seventh Report of the Joint National Committee on Prevention report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Health Core, Inc. The committee reviews are summarized and posted on the NHLBI Web site. Variation in hypertension clinical practice guidelines: a global Health-related quality of life is a psychometrically sound outcome measure for high-cost, high-need populations. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan University of Miami CARRIE ARMSTRONG, AFP Senior Associate Editor, Related editorial: JNC 8: Relaxing the Standards. Framingham, MA, James W. Lohr, M.D. 5-8 Current tools to estimate 10-year risk do not effectively estimate long-term risk of CVD, especially in younger healthier populations. Although 1 post hoc analysis showed a possible advantage in kidney outcomes with the lower target of 130/80 mm Hg recommended by JNC 7, 2 other primary analyses did not support this finding. National High Blood Pressure Education Program Prevention, Detection, Evaluation, and Treatment of . Brooklyn, NY, Leonard M. Steiner, M.S., O.D. The JNC 7 guideline authors also acknowledged that DBP control was more important than SBP control for reducing cardiovascular risk in patients <60 years of age. The Seventh Report of the Joint National Committee on Prevention Department of Veterans Affairs Management of High Blood Pressure in Adults. The new guidelines also introduce new recommendations designed to promote safer use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Note that 1 drink constitutes 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. Centers for Medicare & Medicaid Services Washington, DC, James W. Reed, M.D., F.A.C.P., F.A.C.E. BBs should be generally avoided in patients with asthma, reactive airways disease, or second- or third-degree heart block. The JNC 7 hypertension guidelines. Nakagawa N, Hasebe N. Impact of the 2017 American College of Cardiology/American Heart Association blood pressure guidelines on the next blood pressure guidelines in Asia. Read the current guidelines and following the history and analysis of the 2014 JNC8 guideline, the 2017 Hypertension Guideline from ACC and AHA, the 2018 Guidline from ESC and ESH, and the 2021 USPSTF Recommendation: Screening for Hypertension in Adults. 2003;290(10):1313-1314; author reply 1314-1315. State University of New York at Buffalo School of Medicine JNC 8 at Last! Tulane University Health Sciences Center JNC 8 Guidelines and Hypertension - Verywell Health Buffalo, NY, Vasilios Papademetriou, M.D., F.A.C.P., F.A.C.C. As a result, the new guidelines recommend that patients with chronic kidney disease receive medication sufficient to achieve the higher <140/90 mm Hg goal level. Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence). Serum potassium and creatinine monitored 1?2 times per year. Patients with markedly elevated BP but without acute TOD usually do not require hospitalization, but should receive immediate combination oral antihypertensive therapy. Joint National Committee (JNC) Guidelines For Hypertension Los Angeles, CA, Kenneth A. Jamerson, M.D. New JNC 7 hypertension guidelines Archives of Neurology & Psychiatry (1919-1959), Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force, USPSTF Recommendation: Screening for Hypertension in Adults. American Heart Association Thomas Jefferson University How Low? As a result, for patients over the age of 75 years with decreased renal function, thiazide-type diuretics or CCBs are an acceptable alternative to ACEIs or ARBs. American Dental Association recommendation concluding with high certainty that screening for hypertension in adults has substantial net benefit. 2020 International Society of Hypertension Global Hypertension Practice National Heart, Lung, and Blood Institute Based on these critical issues and concepts, the Executive Committee developed relevant medical subject headings (MeSH) terms and keywords to further review the scientific literature. Learn morehere. Adherence to Hypertension Guidelines in Children, Blood Pressure and GlaucomaA Complex Relationship, A Study of the Causes of Death in 100 Patients With High Blood Pressure, Splanchnicectomy for Essential Hypertension: Results in 1,266 Cases, Effects of Treatment on Morbidity in Hypertension: Results in Patients With Diastolic Blood Pressures Averaging 115 Through 129 mm Hg, Effects Morbidity of Treatment on in Hypertension II: Results in Patients With Diastolic Blood Pressure Averaging 90 Through 114 mm Hg, Five-Year Findings of the Hypertension Detection and Follow-up Program I: Reduction in Mortality of Persons With High Blood Pressure, Including Mild Hypertension, 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), Treatment of Mild Hypertension Study: Final Results, Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials, Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control, Effect of Self-monitoring of Blood Pressure on Detection and Assessment of Hypertension During Higher-Risk Pregnancy: The BUMP 1 and BUMP 2 Trials, Highlights From the American College of Cardiologys Scientific Sessions: New Heart Failure Management Guidelines and more, Does This Adult Patient Have Hypertension? 2023 American Medical Association. US Hypertension Management Guidelines: A Review of the Recent Past and Monitoring Blood Pressure Outside of the Doctor's Office, JAMA Surgery Guide to Statistics and Methods, Antiretroviral Drugs for HIV Treatment and Prevention in Adults - 2022 IAS-USA Recommendations, CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic, Global Burden of Skin Diseases, 1990-2017, Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension, Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning, Organization and Performance of US Health Systems, Spirituality in Serious Illness and Health, The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity, Screening for Prediabetes and Type 2 Diabetes, Statins for Primary Prevention of Cardiovascular Disease, Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer, Statement on Potentially Offensive Content, People older or younger than age 60 years, People aged 18 years with chronic kidney disease. Adults with diabetes and hypertension have reduced mortality as well as improved cardiovascular and cerebrovascular outcomes with treatment to a goal SBP <150 mm Hg, but no randomized controlled trials support a goal <140/90 mm Hg. Farmington, CT, William B. Applegate, M.D., M.P.H. All Rights Reserved. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg. sion guidelines. Influence of Prior Authorization Requirements on Provider Clinical Decision-Making. The change will mean more patients are diagnosed with hypertension. HTN. Similarly, there is no evidence from randomized controlled trials showing that treatment to a systolic pressure of less than 140 mm Hg improves health outcomes in adults with diabetes and hypertension. New York Institute of Technology The JNC 8 Hypertension Guidelines: An In-Depth Guide - AJMC Thiazide-type diuretics for most. The JNC 8 guidelines move away from the assumption that lower blood pressure levels will improve outcomes regardless of the type of agent used to achieve the lower level. Achieve SBP goal especially in persons [[nid:845 view_mode=custom_size width=13 height=14]]50 years of age. Like the JNC 7 panel, the JNC 8 panel recommended thiazide-type diuretics as initial therapy for most patients. Uncomplicated HTN not a reason to restrict physical activity. The Coordinating Committee members served on one of five JNC 7 writing teams, which contributed to the writing and review of the document. The . It advocated managing systolic hypertension in patients over age 50. Hypertens Res. ***Treat patients with chronic kidney disease or diabetes to BP goal of <130/80mmHg. 4 However, BP trends show a clear shift of the highest BPs from high-income to low-income regions, 5 with an estimated 349 million with hypertension in HIC and 1.04 billion in LMICs. 3 When reviewing global figures, an estimated 1.39 billion people had hypertension in 2010. Mayo Clinic Initial antihypertensive treatment should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB in the general nonblack population or a thiazide diuretic or calcium channel blocker in the general black population. Avoid volume depletion and excessively rapid dose titration of drugs. This scheme classifies studies according to a process adapted from Last and Abramson (see Scheme Used for Classification of the Evidence). As in JNC 7, the JNC 8 guidelines also recommend lifestyle changes as an important component of therapy. The Eighth Joint National Committee (JNC 8) recently released evidence-based recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults. American College of Occupational and Environmental Medicine This article reviews the design and content of the new guideline as well as its similarities and differences from JNC 7 and other recently published hypertension guidelines. Centers for Medicare & Medicaid Services Washington, DC, Nancy Houston Miller, R.N., B.S.N. University of Maryland School of Medicine National High Blood Pressure Education Program As a result, the JNC 8 panelists recommend that all patients with chronic kidney disease and hypertension, regardless of ethnic background, should receive treatment with an ACE inhibitor or ARB to protect kidney function, either as initial therapy or add-on therapy. Caution is warranted in patients who are already stable on these therapies. American Academy of Physician Assistants Items on each of the AANPCB certification examinations are reviewed each year by clinical experts for relevancy to current and best practice. Official websites use .gov PDF Hypertension Photo of the Your Guide to Lowering Blood Pressure publication. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines: More Similar Than Different, Prevalence of Hypertension, Treatment, and Blood Pressure Targets in Canada Associated With the 2017 American College of Cardiology and American Heart Association Blood Pressure Guidelines, Blood Pressure ControlMuch Has Been Achieved, Much Remains to Be Done, Media Coverage of the Benefits and Harms of the 2017 Expanded Definition of High Blood Pressure, The New Hypertension Guidelines: Compelling Population Benefit, Manageable Risk, and Time to Implement, Association of Blood Pressure Classification in Young Adults Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Cardiovascular Events Later in Life, Incremental Benefits and Harms of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline, Association of Blood Pressure Classification in Korean Young Adults According to the 2017 American College of Cardiology/American Heart Association Guidelines With Subsequent Cardiovascular Disease Events, The 2017 Hypertension Guideline: Whats New and Different, Association of the 2014 and 2017 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults, Managing Hypertension Part 1: Understanding the New AHA/ACC Hypertension Guideline, Managing Hypertension Part 2: Understanding the New AHA/ACC Hypertension Guideline, 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), Assessing the Trustworthiness of the Guideline for Management of High Blood Pressure in Adults, Guidelines for Managing High Blood Pressure. Patients with marked BP elevations and acute TOD (e.g., encephalopathy, myocardial infarction, unstable angina, pulmonary edema, eclampsia, stroke, head trauma, life-threatening arterial bleeding, or aortic dissection) require hospitalization and parenteral drug therapy. Unlike health care spending, it does not exhibit mean reversion. National Black Nurses Association, Inc. A total of 112 recommendations/keypoints are itemized. Ambulatory BP values are usually lower than clinic readings. American Heart Association Ann Arbor, MI, Norman M. Kaplan, M.D. CCBs useful in Raynaud?s syndrome and certain arrhythmias. American Red Cross It was published in an electronic format on May 14, 2003, and in print on May 21, 2003. Dec. 15, 2022, 1:40 p.m. News Staff The AAFP, following a review of several randomized, controlled trials, has published a new clinical practice guideline on appropriate blood pressure. See permissionsforcopyrightquestions and/or permission requests. May help improve adherence to therapy and evaluate ?white-coat? ABPM is warranted for evaluation of ?white-coat? Systolic BP levels between 120 and 139 mm Hg and diastolic between . Englewood, CO, Sheldon G. Sheps, M.D. Advancing Health Equity Through Medication Formulary Policy. National Stroke Association One of every 3 American adultsor approximately 67 million adults (31%)has hypertension (HTN). These MeSH terms were used to generate MEDLINE searches that focused on English-language, peer-reviewed, scientific literature from January 1997 through April 2003. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. Staying up to date with the JNC 8 hypertension guideline Use of ACE inhibitors and ARBs is recommended in all patients with CKD regardless of ethnic background, either as first-line therapy or in addition to first-line therapy. ndianapolis, IN, Paul K. Whelton, M.D., M.Sc. Quitting smoking also reduces cardiovascular risk. Case Western Reserve University PDF Treatment of Hypertension: JNC 8 and More Philadelphia, PA, John M. Flack, M.D., M.P.H. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 |, 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 43 | 44 |, 45 | 46 | 47 | 48 | 49 | 50 | 51 | 52 | 53 | 54, SLIDE 1: National Heart, Lung, and Blood Institute National High Blood Pressure Education Program Rochester, MN, Laurie Willshire, M.P.H., R.N. Data derived from Gupta. December 18, 2013. Accountable care organizations may influence decisions to pursue surgery in this population. Dallas, TX, Jan N. Basile, M.D., F.A.C.P. The most effective therapy prescribed by the careful clinician will control HTN only if patients are motivated. Agency for Healthcare Research and Quality Dr. Oparil has received funding/grant support for research projects from Abbott Laboratories, Astra-Zeneca, Aventis, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Forest, GlaxoSmithKline, Monarch, Novartis [Ciba], Merck, Pfizer, Sanofi/BioClin, Schering Plough, Schwarz Pharma, Scios Inc, GD Searle, Wyeth Ayerst, Sankyo, Solvay, and Texas Biotechnology Corporation; she has served as a consultant/advisor for Bristol-Myers Squibb, Merck, Pfizer, Sanofi, Novartis, The Salt Institute, and Wyeth- Ayerst; she is also on the Board of Directors for the Texas Biotechnology Corporation. I Have High Blood Pressure: What Do I Need to Know? Privacy Policy| University of Mississippi Medical Center Marshfield Clinic 2 Hypertension accounts for 18% of cardiovascular disease deaths in Western countries. Motivation improves when patients have positive experiences with, and trust in, the clinician.
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