The Eighth Joint National Committee (JNC 8) released its "2014 Evidence-Based Guideline For the Management of High Blood Pressure in Adults" last week. It's been 10 years since JNC 7, and I suspect that many family docs, like myself, have been eagerly awaiting its release.
In JNC 8, a group of experts from multiple fields, including Family Medicine, sifted through the enormous evidence base regarding hypertension treatment. Where no or low-quality evidence exists, they stated as such and made an expert recommendation. I appreciate their transparency in indicating these instances.
The committee sought to answer these 3 questions (directly quoted from the article):
And made the following recommendations (summarized by myself):
- For adults aged 60 and older, treat blood pressure (BP) to a goal of less than 150/90.
- For adults 18-59, treat BP to a goal of less than 140/90. This includes patients with diabetes and/or chronic kidney disease (CKD).
- Initiate treatment with a thiazide diuretic, an ACE inhibitor, an ARB, or a calcium channel blocker (CCB). This includes patients with diabetes.
- No, there were no beta blockers on that last list. Exhaust those other classes before adding a beta blocker. JNC 8 backs this up with solid references; here's one to whet your appetite.
- For African-American patients, consider initiating treatment with a thiazide or a CCB. This includes patients with diabetes.
- Patients with CKD should be on an ACE inhibitor or ARB, regardless of race or co-morbid diseases.
It's unclear, as of yet, how widely these recommendations will be adopted. Will the American Academy of Family Physicians endorse them? How about the American Heart Association and/or the American College of Cardiologists? They will likely want time to examine JNC 8 before stamping a seal of approval upon it, along with the AAFP, who thoughtfully posted an overview of the guidelines along with their plan to review them last week.
I encourage you to check out the article for yourself and draw your own conclusions. Should JNC 8 be the new standard of care?