From the Guidelines
The JNC 8 guidelines recommend initiating antihypertensive medication at blood pressure ≥150/90 mmHg for adults 60 years and older, and ≥140/90 mmHg for those under 60, with consideration of comorbid conditions such as diabetes or chronic kidney disease 1. The guidelines simplify previous recommendations by focusing on a limited number of topics considered to be of utmost importance to clinicians.
- The treatment goals are largely similar whether the patient has “complicated” vs “uncomplicated” hypertension, with fewer drug class recommendations based on comorbid conditions.
- The recommended blood pressure treatment goals differ from those of the JNC-7, with a new goal of less than 150/90 mm Hg for elderly patients (>60 years) in the general population, and less than 140/90 mm Hg for diabetic patients and those with chronic kidney disease.
- The guidelines recommend four main medication classes: thiazide diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs, with specific recommendations for initial therapy based on patient characteristics, such as black patients preferring a thiazide diuretic or CCB. The JNC 8 guidelines emphasize the importance of evidence-based medicine in reducing cardiovascular events, and recommend that treatment decisions be made based on the best available evidence, with consideration of individual patient characteristics and comorbid conditions 1.
- If pharmacological treatment results in a lower blood pressure than the recommended treatment target without serious adverse effects, the pharmacological therapy should be continued.
- The guidelines should be viewed as minimal standards for most patients, with the goal of reducing the risk of stroke, heart attack, and heart failure, particularly in high-risk populations.
From the Research
JNC 8 Guidelines
- The JNC 8 guidelines focus on three highest-ranked clinical questions that include BP thresholds for starting therapy, specific BP goals, and risks and benefits of specific antihypertensive drugs 2.
- The guidelines suggest that the benefit of lowering BP to less than 140/90 is not clear, and lifestyle modifications are considered very important for all patients with hypertension 2.
- The JNC 8 panel only used randomized controlled trial data and did not include observational studies, systematic reviews, or meta-analyses 2.
Blood Pressure Management
- The DASH diet has been shown to lower blood pressure and cardiovascular disease risk, and may have an important role in preventing end-stage kidney disease in select individuals with chronic kidney disease 3.
- Combining two different classes of antihypertensive drugs has an additive effect on lowering of blood pressure, and does not increase adverse events 4.
- Triple therapy with a renin-angiotensin system blocker, CCB, and thiazide diuretic is considered a rational combination for 15%-20% of treated uncontrolled hypertensive patients 4.
DASH Diet
- The DASH diet has been shown to significantly decrease body weight, BMI, and waist circumference, as well as systolic and diastolic blood pressure 5.
- The DASH diet also significantly decreases total cholesterol and LDL-C levels, but not HDL-C, triglycerides, and VLDL-C levels 5.
- The adoption of the DASH diet is accompanied by significant blood pressure reduction in adults with and without hypertension, although higher daily sodium intake and younger age enhance the blood pressure-lowering effect of the intervention 6.