JNC8 guidelines are evidence-based recommendations for all health care providers to manage patients with hypertension. Diagnosis and treatment of hypertension is based on The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (released December 2013). The first goal is to initiate and maintain therapeutic lifestyle changes. This includes aerobic exercise and a low sodium diet.
- people (>/=60 years of age) with no diabetes or chronic kidney disease:
BP goal is < 150/90mm Hg
- people (18-59 years of age) with no comorbidities & people (>/=60 years of age) who have diabetes, chronic kidney disease, or both: BP goal is <140/90mm Hg.
The first line of medication treatments includes 4 classes of medications:
- Thiazide diuretics
- Calcium channel blockers (CCB)
Select a drug titration strategy when using medications:
- Maximize 1st med before adding 2nd or
- Add 2nd med before reaching max dose of 1st med or
- Start with 2 med classes separately or as fixed-dose combination
Thiazide diuretic should be used in African Americans first because African Americans have higher fluid volumes and respond better to diuretics and CCB’s.
If you prescribe an African American an ACE or ARB, make sure give a thiazide diuretic with it.
Beta blockers are no longer a first line of therapy when treating hypertension.
ACE and ARB’s should not be used together in the same patient. Use one or the other to avoid dual renin-angiotension system blockade (hyperkalemia, hypotension, and kidney failure).
ACE and ARB’s is recommended in all patients with chronic kidney disease in addition to first-line therapy.
CCB and thiazide-type diuretics should be used instead of ACE and ARBs in patients older than 75 years of age with impaired kidney function due to risk of hyperkalemia, increased creatinine and renal impairment.
You don’t always have to use JNC8 guidelines. Use your best clinical decision based on assessment and patient’s response. Use the medication that works best and is most effective for your patient.