What are the Joint National Committee 8 (JNC 8) guidelines for hypertension management?

From the Guidelines

The JNC 8 hypertension guidelines recommend initiating treatment in patients aged 60 and older when blood pressure is ≥150/90 mmHg, and in those under 60 when it's ≥140/90 mmHg, with a focus on achieving target blood pressure through medication and lifestyle modifications, as supported by the most recent evidence 1.

Key Recommendations

• For patients with diabetes or chronic kidney disease, treatment should begin at ≥140/90 mmHg regardless of age.
• First-line medication options include thiazide diuretics, calcium channel blockers (CCBs), ACE inhibitors, or ARBs.
• For non-black patients, recommended initial treatments are thiazide diuretics, ACE inhibitors, ARBs, or CCBs.
• For black patients, thiazide diuretics or CCBs are preferred.
• In patients with chronic kidney disease, an ACE inhibitor or ARB should be included in the regimen.

Treatment Approach

• If blood pressure goals aren't achieved within one month, the medication dose should be increased or a second medication added.
• Most patients will require two or more medications to reach their target.
• The guidelines prioritize medications with the strongest evidence for reducing cardiovascular outcomes rather than simply lowering blood pressure numbers, as seen in the comparison of different guidelines 1.

Importance of Blood Pressure Control

• Achieving target blood pressure is crucial for reducing the risk of cardiovascular disease and mortality, as highlighted in the Circulation Research study 1.
• The JNC 8 guidelines aim to simplify previous recommendations and focus on age-specific thresholds, emphasizing the importance of achieving target blood pressure.

From the Research

JNC 8 Hypertension Guidelines

• The JNC 8 guidelines recommend lifestyle modification as the first-line therapy for hypertension, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2.
• The guidelines also recommend first-line drug therapy for hypertension, consisting of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 2.
• The target blood pressure for most people is less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 2.

Lifestyle Modifications

• Lifestyle modifications, such as weight loss, dietary sodium reduction, and potassium supplementation, can help reduce blood pressure and prevent hypertension 3, 4, 5.
• Regular physical activity, stress management, and adequate sleep patterns can also help reduce blood pressure and improve overall health 5.
• A healthy dietary pattern, such as the Dietary Approaches to Stop Hypertension (DASH) eating plan, can help reduce blood pressure and improve cardiovascular health 4, 5.

Reducing Dietary Sodium Intake

• Reducing dietary sodium intake can help lower blood pressure and reduce the risk of cardiovascular disease 6.
• Lifestyle interventions, such as a continuous care model (CCM), can help patients with hypertension reduce their dietary sodium intake and lower their blood pressure 6.

Treatment and Prevention

• The JNC 7 guidelines recommend lifestyle modification strategies, including proper nutrition, weight reduction, increased physical activity, and moderation of alcohol consumption, for the treatment and prevention of hypertension and cardiovascular disease 4.
• Pharmacists can play an important role in managing patients with hypertension by providing lifestyle modification guidance and managing medications 4.