JNC 8 Flashcards
Recommendation 1
General population treatment
In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E)
Recommendation 2
General DBP Goal
In the general population <90 mm Hg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E)
Recommendation 3
General SBP
In the general population <140 mm Hg. (Expert Opinion – Grade E)
Recommendation 4
CKD Goals
In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to goal DBP <90 mm Hg. (Expert Opinion – Grade E)
Recommendation 5
DM Goals
In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to a goal DBP <90 mm Hg. (Expert Opinion – Grade E)
Recommendation 6
Nonblack Tx
In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)
Recommendation 7
Black Tx
In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation – Grade C)
Recommendation 8
CKD Tx
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)
Recommendation 9
Main Objective for Tx
The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)
SBP vs DBP control
In younger patients without major comorbidities, elevated DBP is a more important cardiovascular risk factor than is SBP. Results showed a reduction in cerebrovascular events, heart failure, and overall mortality in patients treated to the DBP target level
In patients 60 years of age and older, SBP control remains the most important factor
Initial meds to trial
ACE I, ARB, CCB, TTD
DO NOT use ACE I’s and ARBs together on the same pt
Do not start with BB, combo ab blockers, alpha blockers, or direct vasodilators
Lifestyle modifications
Dietary Approaches to Stop Hypertension (DASH) eating plan
weight loss
reduction in sodium intake to less than 2.4 grams per day
30 minutes of aerobic activity most days of the week
alcohol intake limited to 2 drinks per day in men and 1 drink per day in women
