What is the target systolic blood pressure according to the Joint National Committee (JNC) for a patient newly diagnosed with Hypertension (HTN)?

Target Systolic Blood Pressure According to JNC Guidelines

For a newly diagnosed hypertensive patient, the target systolic blood pressure according to JNC-8 is <140 mm Hg for most adults, with the exception of patients ≥60 years old without diabetes or chronic kidney disease, where the target is <150 mm Hg. 1

JNC-8 Blood Pressure Targets by Age and Comorbidity

General Adult Population (Age <60 years)

• Target: <140/90 mm Hg based on expert opinion, as there is insufficient evidence for a specific systolic goal in adults younger than 60 years 1
• For adults aged 30-59 years, there is strong evidence supporting a diastolic goal of <90 mm Hg 1

Older Adults (Age ≥60 years)

• Target: <150/90 mm Hg for patients without diabetes or chronic kidney disease, based on strong evidence from randomized controlled trials 1
• This represents a significant departure from JNC-7, which recommended <140/90 mm Hg for all adults 2

Patients with Diabetes or Chronic Kidney Disease (All Ages)

• Target: <140/90 mm Hg regardless of age 2, 1
• JNC-8 moved away from the more aggressive JNC-7 target of <130/80 mm Hg for these populations 2, 3

Evolution from JNC-7 to JNC-8

The shift between guidelines is clinically important:

• JNC-7 (2003) recommended <140/90 mm Hg for the general population and <130/80 mm Hg for patients with diabetes or chronic kidney disease 2, 3
• JNC-8 (2014) relaxed targets to <150/90 mm Hg for adults ≥60 years and <140/90 mm Hg for those with diabetes or CKD (all ages) 2, 1

Critical Controversy Regarding the Answer Options

The correct answer depends on which JNC guideline is being referenced:

• If referring to JNC-7: The answer is C) <140 mm Hg for the general population 2, 3
• If referring to JNC-8: The answer is C) <140 mm Hg for adults <60 years, or D) <150 mm Hg for adults ≥60 years without diabetes/CKD 1

Important Clinical Caveat

The JNC-8 recommendation for <150/90 mm Hg in older adults was highly controversial and opposed by a significant minority of panel members who preferred maintaining the <140/90 mm Hg target 2, 4. Multiple other major guidelines including the European Society of Hypertension/European Society of Cardiology, Canadian Hypertension Education Program, and American College of Cardiology/American Heart Association have maintained <140/90 mm Hg as the target for most adults aged 60-79 years 2, 4.

Practical Algorithm for Target Selection

For a newly diagnosed hypertensive patient:

1. Determine age: If <60 years → target <140/90 mm Hg 1
2. If ≥60 years, assess for diabetes or CKD:
   • Present → target <140/90 mm Hg 1
   • Absent → target <150/90 mm Hg per JNC-8 1, though many experts recommend <140/90 mm Hg 2, 4
3. Consider frailty and tolerability: More lenient targets may be appropriate for very elderly or frail patients 5

Given the question asks specifically about "the Joint National Committee" without specifying JNC-7 or JNC-8, and considering JNC-8 is the most recent JNC guideline, the answer for a general newly diagnosed patient would be C) <140 mm Hg, as this applies to the majority of newly diagnosed patients who are typically <60 years old.