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Implementing effective hypertensive management--review of the 2014 high blood pressure management guidelines
Insights
The updated Joint National Committee (JNC 8) hypertension guidelines categorize patients by atherosclerotic cardiovascular disease (ASCVD) or chronic kidney disease (CKD) risk. New blood pressure goals and first-line therapies are outlined for improved hypertension management.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- The Joint National Committee (JNC 8) guidelines provide updated recommendations for hypertension management.
- Hypertension is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD).
Purpose of the Study:
- To elucidate the modifications in blood pressure goals and therapeutic strategies outlined in the JNC 8 hypertension guidelines.
- To assist clinicians in optimizing the clinical care of patients with hypertension based on updated recommendations.
Main Methods:
- Categorization of patients into low-risk and high-risk populations based on age, ASCVD, and CKD status.
- Review of current recommendations for blood pressure targets in different patient categories.
- Identification of first-line antihypertensive pharmacotherapy agents.
Main Results:
- Patients are now classified as low-risk (≥60 years without ASCVD/CKD risk factors) or high-risk (CKD/diabetes, or <60 years with risk factors).
- Recommended blood pressure goals are 150/90 mmHg for low-risk and 140/90 mmHg for high-risk populations.
- First-line therapies include thiazide-type diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs); beta-blockers are not recommended as standalone therapy.
Conclusions:
- The JNC 8 guidelines introduce a risk-based approach to hypertension management, modifying blood pressure targets.
- Specific antihypertensive drug classes are recommended as first-line agents, with considerations for patient subgroups like African Americans and those with CKD.
- Clinicians should adapt their treatment strategies to align with these updated JNC 8 recommendations for effective hypertension control.
Abstract:
The Joint National Committee (JNC 8) hypertension guidelines have modified the blood pressure goals across the spectrum of disease processes and patient characteristics. This article will elucidate these changes and help clinicians improve the clinical care of patients with hypertension. Patients are now conceptually categorized into two different patient populations: those who are at a low- or high-risk of developing atherosclerotic cardiovascular disease (ASCVD) or chronic kidney disease (CKD). A low-risk population comprises patients aged 60 or older who do not have disease processes that enhance ASCVD or CKD disease development. High-risk patients are those with CKD and/or diabetes, and patients less than 60 years of age who remain at risk of future development. The current recommendation for blood-pressure goals in the low- and high-risk population is 150/90 mmHg and 140/90 mmHg, respectively. In all patients considered for antihypertensive therapy, the first line antihypertensive pharmacotherapy should include either a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or an angiotensin receptor blocker (ARB). Beta blockers no longer have a role as standalone therapy. Thiazide- type diuretics and CCB continue to demonstrate benefit in the African American population and should continue to be considered as first line agents. CKD patients with concomitant hypertension should be treated with an ACE inhibitor or ARB.
