NEW JNC 8 HYPERTENSION GUIDELINES DRAW CRITICISM
Controversial new guidelines on the management of hypertension released by the 8th Joint National Committee (JNC 8) recommend higher blood pressure (BP) thresholds for treatment, prompting a mix of responses with some experts even calling for their retraction.
Essentially, the new guidelines recommend treating anyone over 60 years of age if they have a BP of ≥150/90 mmHg. For younger individuals and patients with diabetes or kidney disease regardless of age, they suggest treatment should be initiated when BP is 140/90 mm Hg or higher. [JAMA 2013; doi:10.1001/jama.2013.284427]
The major difference between the new guidelines and the previous JNC 7 guidelines focuses on whether target BP treatment goals should be more conservative. The JNC 7 recommended a target BP of <140/90 mmHg in adults and <130/80 mm Hg in those with chronic kidney disease or diabetes.
While the new guidelines raise the BP threshold, it doesn’t mean clinicians should ease up on treatment in patients doing well on medications recommended by the JNC 7 guidelines, said JNC 8 panel co-chair Dr. Paul A. James from the University of Iowa in Iowa City, Iowa, US. “We’re not saying that if someone’s [systolic] BP is 140 or 135 mm Hg on medicine and they’re doing well that you need to take them off medicines and get their BP closer to 150. If you can consistently get people’s BP below 150 mm Hg, you really are improving their health outcomes.”
The updated guidelines also backed away from recommending only thiazide diuretics as initial therapy and suggest that an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin-receptor blocker (ARB), or a calcium channel blocker (CCB), are reasonable choices.
If BP goal is not reached within a month of treatment, the recommendation is to increase the dose of the initial drug or add a second drug from the same list. If the targeted BP is not reached within 2 months, a third drug from the same list can be added and titrated. However, an ACE inhibitor and an ARB cannot be used concurrently in the same patient.
Antihypertensive drugs from other classes can be used if BP goal is not reached using only three drugs from the list. If this strategy fails, patients can be referred to hypertension specialists.
The recommendations were based on RCT evidence and differ from other guidelines that recommended treatment based on observational studies. Other guidelines, including those from the European Society of Hypertension, recommend a BP goal of <150 mmHg, but in patients >65 years of age.
Dr. Eric Peterson from the Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, said the new recommendations simplify the treatment targets and remove the lower thresholds for diabetes and kidney disease. [JAMA 2013; doi:10:1001/jama.2013.284430]
He added larger RCTs are needed to compare BP thresholds in different populations as well as a national consensus group to draft a new comprehensive practice guideline that would harmonize hypertension guideline with other cardiovascular risk guidelines. Finally, patients and physicians should work together to achieve BP goals.
While JNC 8 has gone extensive review by experts, it has not been evaluated or sponsored by any specialty societies such as the AHA and the ACC, a departure from the usual practice which has sparked some discussion.
In an accompanying editorial, Dr. Harold Sox of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, US, said some aspects of the external review process may undermine public confidence. He said the guideline was not published in draft form to elicit public comments. [JAMA 2013; doi:10.1001/jama.2013.284429]
JAMA editor-in chief Dr. Howard Bauchner, in another editorial, acknowledged the areas of controversy and said that he anticipates debates and discussions regarding its clinical application. [JAMA 2013; doi:10.1001/jama.2013.284432] — in Tiruchirappalli.
Controversial new guidelines on the management of hypertension released by the 8th Joint National Committee (JNC 8) recommend higher blood pressure (BP) thresholds for treatment, prompting a mix of responses with some experts even calling for their retraction.
Essentially, the new guidelines recommend treating anyone over 60 years of age if they have a BP of ≥150/90 mmHg. For younger individuals and patients with diabetes or kidney disease regardless of age, they suggest treatment should be initiated when BP is 140/90 mm Hg or higher. [JAMA 2013; doi:10.1001/jama.2013.284427]
The major difference between the new guidelines and the previous JNC 7 guidelines focuses on whether target BP treatment goals should be more conservative. The JNC 7 recommended a target BP of <140/90 mmHg in adults and <130/80 mm Hg in those with chronic kidney disease or diabetes.
While the new guidelines raise the BP threshold, it doesn’t mean clinicians should ease up on treatment in patients doing well on medications recommended by the JNC 7 guidelines, said JNC 8 panel co-chair Dr. Paul A. James from the University of Iowa in Iowa City, Iowa, US. “We’re not saying that if someone’s [systolic] BP is 140 or 135 mm Hg on medicine and they’re doing well that you need to take them off medicines and get their BP closer to 150. If you can consistently get people’s BP below 150 mm Hg, you really are improving their health outcomes.”
The updated guidelines also backed away from recommending only thiazide diuretics as initial therapy and suggest that an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin-receptor blocker (ARB), or a calcium channel blocker (CCB), are reasonable choices.
If BP goal is not reached within a month of treatment, the recommendation is to increase the dose of the initial drug or add a second drug from the same list. If the targeted BP is not reached within 2 months, a third drug from the same list can be added and titrated. However, an ACE inhibitor and an ARB cannot be used concurrently in the same patient.
Antihypertensive drugs from other classes can be used if BP goal is not reached using only three drugs from the list. If this strategy fails, patients can be referred to hypertension specialists.
The recommendations were based on RCT evidence and differ from other guidelines that recommended treatment based on observational studies. Other guidelines, including those from the European Society of Hypertension, recommend a BP goal of <150 mmHg, but in patients >65 years of age.
Dr. Eric Peterson from the Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, said the new recommendations simplify the treatment targets and remove the lower thresholds for diabetes and kidney disease. [JAMA 2013; doi:10:1001/jama.2013.284430]
He added larger RCTs are needed to compare BP thresholds in different populations as well as a national consensus group to draft a new comprehensive practice guideline that would harmonize hypertension guideline with other cardiovascular risk guidelines. Finally, patients and physicians should work together to achieve BP goals.
While JNC 8 has gone extensive review by experts, it has not been evaluated or sponsored by any specialty societies such as the AHA and the ACC, a departure from the usual practice which has sparked some discussion.
In an accompanying editorial, Dr. Harold Sox of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, US, said some aspects of the external review process may undermine public confidence. He said the guideline was not published in draft form to elicit public comments. [JAMA 2013; doi:10.1001/jama.2013.284429]
JAMA editor-in chief Dr. Howard Bauchner, in another editorial, acknowledged the areas of controversy and said that he anticipates debates and discussions regarding its clinical application. [JAMA 2013; doi:10.1001/jama.2013.284432] — in Tiruchirappalli.
![Photo: NEW JNC 8 HYPERTENSION GUIDELINES DRAW CRITICISM
Controversial new guidelines on the management of hypertension released by the 8th Joint National Committee (JNC 8) recommend higher blood pressure (BP) thresholds for treatment, prompting a mix of responses with some experts even calling for their retraction.
Essentially, the new guidelines recommend treating anyone over 60 years of age if they have a BP of ≥150/90 mmHg. For younger individuals and patients with diabetes or kidney disease regardless of age, they suggest treatment should be initiated when BP is 140/90 mm Hg or higher. [JAMA 2013; doi:10.1001/jama.2013.284427]
The major difference between the new guidelines and the previous JNC 7 guidelines focuses on whether target BP treatment goals should be more conservative. The JNC 7 recommended a target BP of <140/90 mmHg in adults and <130/80 mm Hg in those with chronic kidney disease or diabetes.
While the new guidelines raise the BP threshold, it doesn’t mean clinicians should ease up on treatment in patients doing well on medications recommended by the JNC 7 guidelines, said JNC 8 panel co-chair Dr. Paul A. James from the University of Iowa in Iowa City, Iowa, US. “We’re not saying that if someone’s [systolic] BP is 140 or 135 mm Hg on medicine and they’re doing well that you need to take them off medicines and get their BP closer to 150. If you can consistently get people’s BP below 150 mm Hg, you really are improving their health outcomes.”
The updated guidelines also backed away from recommending only thiazide diuretics as initial therapy and suggest that an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin-receptor blocker (ARB), or a calcium channel blocker (CCB), are reasonable choices.
If BP goal is not reached within a month of treatment, the recommendation is to increase the dose of the initial drug or add a second drug from the same list. If the targeted BP is not reached within 2 months, a third drug from the same list can be added and titrated. However, an ACE inhibitor and an ARB cannot be used concurrently in the same patient.
Antihypertensive drugs from other classes can be used if BP goal is not reached using only three drugs from the list. If this strategy fails, patients can be referred to hypertension specialists.
The recommendations were based on RCT evidence and differ from other guidelines that recommended treatment based on observational studies. Other guidelines, including those from the European Society of Hypertension, recommend a BP goal of <150 mmHg, but in patients >65 years of age.
Dr. Eric Peterson from the Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, said the new recommendations simplify the treatment targets and remove the lower thresholds for diabetes and kidney disease. [JAMA 2013; doi:10:1001/jama.2013.284430]
He added larger RCTs are needed to compare BP thresholds in different populations as well as a national consensus group to draft a new comprehensive practice guideline that would harmonize hypertension guideline with other cardiovascular risk guidelines. Finally, patients and physicians should work together to achieve BP goals.
While JNC 8 has gone extensive review by experts, it has not been evaluated or sponsored by any specialty societies such as the AHA and the ACC, a departure from the usual practice which has sparked some discussion.
In an accompanying editorial, Dr. Harold Sox of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, US, said some aspects of the external review process may undermine public confidence. He said the guideline was not published in draft form to elicit public comments. [JAMA 2013; doi:10.1001/jama.2013.284429]
JAMA editor-in chief Dr. Howard Bauchner, in another editorial, acknowledged the areas of controversy and said that he anticipates debates and discussions regarding its clinical application. [JAMA 2013; doi:10.1001/jama.2013.284432]](https://fbcdn-sphotos-a-a.akamaihd.net/hphotos-ak-frc1/t1.0-9/1795748_648043888588018_781880209_n.jpg)
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