JohanSundstrm,MD, PhD, LarsLind,MD, PhD et al. One of every 3 American adultsor approximately 67 million adults (31%)has hypertension (HTN). Dr. Black has received honoraria for serving as a speaker from Astra-Zeneca, Bristol-Myers Squibb, Novartis, Pfizer, Pharmacia, and Wyeth-Ayerst; he has received funding/grant support for research projects from Bristol-Myers Squibb, Boehringer- Ingelheim, Merck, Pfizer, and Pharmacia; he has served as a consultant/advisor for Abbott, Astra- Zeneca, Biovail, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Pfizer, and Pharmacia. Thomas Jefferson University Marshfield Clinic Changes between the 2022 and 2015/2017 Taiwan Hypertension Guidelines, new recommendations, and the "not to do" list are summarized in Tables 1A . reducing calories, saturated fat, and salt in processed foods and increasing community/school opportunities for physical activity) can achieve a downward shift in the distribution of a population?s BP, thus potentially reducing morbidity, mortality, and the lifetime risk of an individual?s becoming hypertensive. The JNC 8 guideline authors simplified a complicated recommendation for followup in patients with hypertension. Atlanta, GA, Lee Shaughnessy Morehouse School of Medicine In addition, 33 national hypertension leaders reviewed and commented on the document. Centers for Medicare & Medicaid Services Eye Group Like the JNC 7 panel, the JNC 8 panel recommended thiazide-type diuretics as initial therapy for most patients. Triple therapy with an ACE inhibitor/ARB, CCB, and thiazide-type diuretic would precede use of alpha-blockers, beta-blockers, or any of several other agents. Dementia and cognitive impairment occur more commonly in people with HTN. SBP Distributions, SLIDE 53: Your Guide to Lowering Blood Pressure. Is There a Role for Renal Denervation in the Treatment of Hypertension? SUNY Health Science Center at Brooklyn ACE inhibitors and ARBs may not be an ideal choice in patients of African descent. [Epub ahead of print]. Mason, OH, Rita D. Strickland, Ed.D., R.N. The Coordinating Committee began the process of developing the JNC 7 Express report in December 2002, and the report was submitted to the Journal of the American Medical Association in April 2003. BBs useful in the treatment of atrial tachyarrhythmias/fibrillation, migraine, thyrotoxicosis (short-term), essential tremor, or perioperative HTN. National High Blood Pressure Education Program Prevention, Detection, Evaluation, and Treatment of . The JNC 8 panel does not recommend first-line therapy with beta-blockers and alpha-blockers due to 1 trial that showed a higher rate of cardiovascular events with use of beta-blockers compared with use of an ARB, and another trial in which alpha-blockers resulted in inferior cardiovascular outcomes compared with use of a diuretic. American College of Physicians Before receiving alpha-blockers, betablockers, or any of several miscellaneous agents, under the JNC 8 guidelines, patients would receive a dosage adjustment and combinations of the 4 first-line therapies. Wake Forest University School of Medicine 3 When reviewing global figures, an estimated 1.39 billion people had hypertension in 2010. These new guidelines all but eliminate use of beta-blockers (including nebivolol), alpha-blockers, loop diuretics, alpha 1/beta-blockers, central alpha2/adrenergic agonists, direct vasodilators, aldosterone antagonists, and peripherally acting adrenergic antagonists in patients with newly diagnosed hypertension. In many instances, the principal investigator of the larger studies has presented the information directly to the Coordinating Committee. 2020 International Society of Hypertension Global Hypertension Practice New York, NY, C. Venkata S. Ram, M.D. Health Resources and Services Administration Houston, TX, Howard S. Weiss, M.D., M.P.H. Guidelines for High Blood Pressure in Adults - JAMA Network New Orleans, LA. 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. Heartbeats Life Center American Pharmaceutical Association New Orleans, LA, Ray W. Gifford, Jr., M.D., M.S. Charleston, SC, William J. Elliott, M.D., Ph.D. Copyright 2014 by the American Academy of Family Physicians. Mayo Clinic and Mayo Medical School Englewood, CO, Sheldon G. Sheps, M.D. 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. *Treatment determined by highest BP category. American Hospital Association PDF Hypertension Diagnosis and Treatment Guideline 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. Indiana University School of Medicine Charleston, SC, James I. Cleeman, M.D. Second- and third-line alternatives included higher doses or combinations of ACE inhibitors, ARBs, thiazide-type diuretics, and CCBs. American Academy of Ophthalmology It includes modification of JNC 7 regarding the threshold for therapy, therapeutic goals, and medications or combinations of medications that differ in benefits for certain . The 2017 guideline is a comprehensive guideline incorporating new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension tre. To improve blood pressure control and reduce cardiovascular disease (CVD) risk in these patients, a small percentage of . 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. JNC7 | JNC6 | JNC5 | For persons over age 50, SBP is a more important than DBP as CVD risk factor. Shared Decision Making Amidst Shifting (Hypertension) Guidelines, New Guideline for Treatment of High Blood Pressure in Adults. National Stroke Association Caution is warranted in patients who are already stable on these therapies. Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). The Seventh Report of the Joint National Committee on Prevention In the general nonblack population, including those with diabetes, initial anti-hypertensive treatment should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB). Dean S.Picone,PhD, NiamhChapman,PhD et al. Get this for the health professional or researcher who needs to understand the full scope and significance of the new findings on high blood pressure. Advancing Health Equity Through Medication Formulary Policy. Thiazide-type diuretics should be initial drug therapy for most, either alone or combined with other drug classes. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. National Medical Association Dr. Carter has served as a consultant/advisor for Bristol-Myers Squibb. PDF Treatment of Hypertension: JNC 8 and More 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. The New Hypertension Guidelines - PMC There was no observed additional benefit in preventing stroke with the lower blood pressure target. In patients 18 to 59 years of age without major comorbidities, and in patients 60 years or older who have diabetes, chronic kidney disease (CKD), or both conditions, the new goal blood pressure level is <140/90 mm Hg. Drug choices similar in children and adults, but effective doses are often smaller. Despite the subgroup analysis of ALLHAT, results of the African American Study of Kidney Disease and Hypertension (AASK) support use of first-line or add-on ACEIs to improve kidney-related outcomes in patients of African descent with hypertension, CKD, and proteinuria. University of Michigan Medical Center Other risk factors should be managed aggressively. A .gov website belongs to an official government organization in the United States. Rush University Medical Center 2023 American Medical Association. New Guidance on Blood Pressure Management in Low-Risk Adults with Stage Assess the presence or absence of target organ damage and CVD. Medical College of Georgia However, more conservative panelists pushed to keep the target SBP goal as well as the DBP goal. Recent Guidelines for Hypertension | Circulation Research Compared with previous hypertension treatment guidelines, the Joint National Committee (JNC 8) guidelines advise higher blood pressure goals and less use of several types of antihypertensive medications. Feinberg School of Medicine, Northwestern University In general, treatment similar for all demographic groups. 2020 International Society of Hypertension Global Hypertension Practice In younger patients without major comorbidities, elevated DBP is a more important cardiovascular risk factor than is elevated SBP. Patients should return for followup and adjustment of medications until the BP goal is reached. 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. National Heart, Lung, and Blood Institute University Hospitals of Cleveland Microalbuminuria or estimated GFR <60 ml/min, Age (older than 55 for men, 65 for women), Family history of premature CVD (men under age 55 or women under age 65), Chronic steroid therapy and Cushing?s syndrome, Serum potassium, creatinine, or the corresponding estimated GFR, and calcium, Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides, Measurement of urinary albumin excretion or albumin/creatinine ratio, More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved, Classification and management of BP for adults. Physicians should consider their patients? Winston Salem, NC, Robert Carey, M.D., Wayne State University School of Medicine Lower initial drug doses may be indicated to avoid symptoms; standard doses and multiple drugs will be needed to reach BP targets. Target blood pressure goal (according to JNC VII) - 140/90 mm Hg for all, except patients with diabetes, chronic renal disease & BP below 130/80 mm Hg. JAMA 2013 Dec 18. doi: 10.1001/jama.2013.284427. As in JNC 7, the JNC 8 guidelines also recommend lifestyle changes as an important component of therapy. 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. Dallas, TX, Elijah Saunders, M.D., F.A.C.C., F.A.C.P. Use auscultatory method with a properly calibrated and validated instrument. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2023 American Medical Association. (CKD), and emphasizes lifestyle interventions as primary treatment, with consideration of antihypertensive drug therapy only in adults at very high risk, eg with established CVD. Quitting smoking also reduces cardiovascular risk. The JNC 7 panel recommended that after an initial high blood pressure reading, followup with a confirmatory blood pressure reading should occur within 7 days to 2 months, depending on how high the initial reading was and whether or not the patient had kidney disease or end-organ damage as a result of hypertension. International Society on Hypertension in Blacks 2. Indiana University School of Optometry Chicago, IL, Henry R. Black, M.D. Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and value. Bethesda, MD, Richard A. Uncomplicated HTN not a reason to restrict physical activity. 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?
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