Joint national committee 8 jnc 8 guidelines for management. The jnc8 guidelines differ from the jnc 7 guidelines in two key areas. Background the recently published sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc vi includes a classification of blood pressure stages and a new risk stratification component. Revisiting the jnc 7 recommendations jeffery martin, m. Jnc 8 hypertension guideline algorithm lifestyle changes. Nov, 2017 high blood pressure remains a leading public health threat. Clinical practice guidelines for the management of hypertension in the community. Pdf the seventh report of the joint national committee on prevention. It is a primary risk factor for cardiovascular disease and its prevention and management is central to preserving and promoting the cardiovascular health of the nation. A variety of factors, such as gestational age, postconceptional age and birth weight needs to be taken into account when deciding if a blood pressure is normal in a newborn. Now, just 2 years after publication of jnc 7, the american society of hypertension ash has realized a need to revise their definition of hypertension and recommendations for its recognition and treatment. Smoking cessation control blood glucose and lipids diet eat healthy i. Numerous evidencedbased interventions are available to prevent high blood pressure and improve high blood pressure. Methods the decision to appoint a committee for the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 was based on 4 factors.
Jnc8 hypertension guidelines 2014 tools to enhance uptake susan l. Crossclassification of jnc vi blood pressure stages and risk groups among individuals with highnormal blood pressure and hypertension in the framingham heart study 1. This is a vital issue because the major proportion of people with hypertension are in this age group and are at high levels of cardiovascular. Recently published hypertension guidelines of the jnc 8. Explore jnc 8 hypertension guidelines from jama network. Blood pressure jnc7 provides additional scien tific evidence to. Jnc 8 guidelines for the management of hypertension in adults. Not available, the sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure arch intern med. Hypertension and european society of cardiology jnc 8 versus jnc 7 understanding the evidences i research article. High blood pressure typically does not cause symptoms. Nuevas guias del american college of cardiologyamerican.
The treatment of arterial hypertension should start before significant cardiovascular damage develops and is usually lifelong. Staying up to date with the jnc 8 hypertension guideline jaapa journal of the american academy of physician assistants. The criteria for a diagnosis of hypertension are the same in jnc7 and jnc 8. Pdf on jan 1, 2014, michael r page and others published the jnc 8 hypertension guidelines. Crossclassification of jnc vi blood pressure stages and risk. Although these guidelines provide evidencebased recommendations for the management of hypertension. Jnc 8 vs ash ish similarities general agreement on targets and treatment, both have. Pdf the seventh report of the joint national committee on. The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure national institutes of health. Betablocker is not an firstline for patients without coronary artery disease except esh. Boston university school of medicine, boston, ma executive committee george l. Arterial bp is generated hemodynamically by the interplay between what two things.
Treatment recommendations for hypertension as outlined in the sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc vi are constantly evolving and being refined as new information on the disease becomes evident. A view from a member of jnc 7 benefit either as 1 st or 2 ndline therapy ctd twice as potent as hctz ctd longer duration of action hctz 2550 mgd vs. Jnc 8 and more hypertension guidelines from the eighth joint national committee jnc 8 are finally here. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure provides a new guideline for hypertension prevention and management. Definition and stages of hypertension according to jnc 7jnc. However, if classified as prehypertensive, they would place demands on the medical system that could divert resources from. Jnc 8 only answers a few new questions for the primary care physician, mostly focused on hypertension treatment recommendations. May 30, 2003 using jnc 7 as a point of departure, an editorialist argues that hypertension control will improve only with substantial changes in the delivery of chronicdisease care and in how the public views lifestyle changes. The eighth joint national committee jnc 8 guidelines on hypertension have generated great interest among physicians. Hypertension 1 update, jnc8 and beyond tara shrout, david w rudy2 and michael t piascik3 hypertension is the most preventable major risk factor for cardiovascular morbidity and mortality. Blood flow cardiac outpout co and total peripheral resistance tpr.
However, individuals with numerous disease markers table iii or limited evidence of early target organ damage such as left ventricular. Another change in classification from jnc 6 is the combining of stage 2 and. Detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal 65% in persons older than 60 yrs, 1 in 3 adults hypertension disproportionately affects the african american community with over 45% aa males and 46% aa females affected by high blood pressure compared to a national rate of 33%. Ivey, md, mhsa professor, school of pub health university of california, berkeley. Thus, jnc7 is still the final word for several elements of hypertension that jnc 8 did not address, particularly regarding screening, evaluation, diagnosis and classification of high blood pressure. Hypertension can be simply defined as meeting one of three criteria. This does not include learn with flashcards, games, and more for free.
Jaap 45 hypertension, resistant hypertension, or lifestyle interven. Special communication clinicians corner the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure the jnc 7 report aram v. Results in patients with diastolic blood pressures averaging 115. Pdf staying up to date with the jnc 8 hypertension guideline. Young women with blood pressures of 12080 mm hg are at very low absolute risk of adverse cardiovascular events. I am concerned that the prehypertension classification in the jnc 7 guidelines 1 threatens to medicalize most of the adult population. Treatment of secondary forms of hypertension differs widely. Several emphasize superiority of chlorthalidone or indapamide over thiazide diuretics, and loop diuretics reserved for heart failure or chronic.
An additional recommendation was to combine small doses of. Longterm high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral arterial disease, vision. Blood pressure goals for hypertension control, jnc 1jnc 7. For persons with diastolic blood pressures of 90104mm hg, the recommendation was to individualize drug therapy, giving consideration to other. Many patients find out that they have hypertension during routine medical examinations. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd.
Guidelines represent consensus statements by expert panels, and the process of guideline development has inherent vulnerabilities. The jnc 7 hypertension guidelinesthe jnc 7 hypertension. Drug resistant hypertension not mentioned in jnc defined as not controlled on 3 drugs ash ish. The eighth joint national committee guidelines jnc 8 published in 2014 provides evidence based recommendations for management of hypertension and is an important reference for clinicians. The 20 joint european society of hypertension esh and the european society of cardiology esc guidelines recommend that ambulatory bloodpressure monitoring abpm be incorporated into the assessment of cardiovascular risk factors and hypertension. In the case of an active competitive athlete, it is recommended that once the blood pressure is well controlled, regular followup should be continued with by. Sustained increased arterial pressure can cause damage to the blood vessels in the heart, kidneys, or brain and ultimately leads to an increased incidence of renal failure, congestive heart failure, coronary disease, and stroke. The jnc 7 executive committee and writing teams were selected entirely from the nhbpep. For example, jnc 7 and other guidelines recommended treatment to lower bp goals in patients with diabetes and ckd based on observational. The etiology of elevated blood pressure is a complex process involving the interaction of genetics, demographics, comorbid disorders, and environmental. To accomplish this, the society established the writing group of the american society of hypertension wgash, chaired by dr.
High blood pressure remains a leading public health threat. The aim of the update was to provide simplified recommendations for the management of blood pressure based on evidence from randomized controlled trials and the panels expert opinion. Secondary forms of hypertension are rare and the origin could be. Hypertension is the most significant cardiac risk factor in older adults. Definition and stages of hypertension according to jnc 7. Hypertension is defined as consistently having a systolic blood pressure of 140 mm hg or a diastolic blood pressure of 90 mm hg. The seventh report of the joint national committee on the. Correction is appended to this pdf and also available at. Citizens for public action on high blood pressure and cholesterol, inc. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure iii chair aram v. Blood pressure jnc7 provides additional scien tific evidence.
The aim of the new and challenging definition of prehypertension bp 12098089. Hypertension is a common disorder that affects approximately 1 billion people and contributes to 1 in 8 deaths. The seventh report of the joint national committee on. Reference card from the seventh report of the joint. Treatment of high blood pressure jnc 7 was based on 4 factors. Individuals with ash stage 2 hypertension jnc 7 stage 1 hypertension frequently have sustained resting bp levels 140. Seventh report of the joint national committee on prevention. Treatment of systemic hypertension 161 am j cardiovasc dis 2012. Hypertension affects 29% us adult population estimated 72 million people, with a prevalence of 65% in persons older than 60 yrs, 1 in 3 adults hypertension disproportionately affects the african american community with over 45% aa males and 46% aa females affected by high blood pressure compared to a national rate of 33%. Bakris, md tection, evaluation, and treatment of high blood. Each one was developed after continuous study and randomized control trials. Definitions from lecture 1 hypertension slides 729, 8592. Jnc 8 hypertension guideline algorithm initial drugs of.
At the heart of the recommendations is the idea that being overly aggressive in bp management may cause more problems with side effects than you gain in stroke and heart attack prevention. The jnc 7 executive committee and writing teams were selected entirely from the nhbpep cc because they are recognized as experts in their disciplines by their peers. Jnc8 guidelines for the management of hypertension in adults. Bakris, md tection, evaluation, and treatment of high blood pressure.
Hypertension is an easily diagnosed and potentially easily treated problem. Some new and important features characterize the jnc 7 document. Failure to titrate or combine medications, despite knowing the patient is not at goal bp. Now, just 2 years after publication of jnc7, the american society of hypertension ash has realized a need to revise their definition of hypertension and recommendations for its recognition and treatment. Patients with highnormal blood pressure or hypertension are stratified into risk group a no associated cardiovascular. While we were waiting for jnc 8, the american society of hypertension ash in collaboration with the international society of hypertension released their own expert opinion piece aimed at prescribers. Cuff inflation hypertension extracellular fluid volume expansion dietary sodium excess obstructive sleep apnea secondary hypertension chronic kidney disease rvh note recent coral trial endocrine hypertension pheochromocytoma, primary mineralocorticoid, etc central hypertension. Hypertension guidelines provide uptodate information and recommendations for hypertension management to healthcare providers, and they facilitate translation of new knowledge into clinical practice. The eighth joint national committee guidelines jnc 8 published in 2014 provides evidence based recommendations for management of hypertension and. The 2015 canadian hypertension education program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Chobanian and his colleagues setand meta goal of completnational high blood pressure.
May 07, 2014 5 thoughts on changes in hypertension treatment. Comparison of hypertension guidelines 20112014 treat if bp. The sixth report of the joint national committee on. Using jnc 7 as a point of departure, an editorialist argues that hypertension control will improve only with substantial changes in the delivery of chronicdisease care and in how the public views lifestyle changes.
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