By Monica Gupta, MD
On December 18, 2013, the long awaited JNC 8 guidelines were published. Two major deviations from JNC 7 are: 1) more relaxed blood pressure goals and cutoffs for initiation of treatment, and 2) recommendations for first line therapy.
Simplified, JNC 8’s major recommendations are as follows:
- In those 60 years or older, blood pressure lowering agents should be initiated to achieve a goal SBP < 150 mmHg and a goal DBP < 90 mmHg.
- In those 60 years or younger, blood pressure lowering agents should be initiated for a goal SBP < 140 mmHg and a goal DBP < 90 mmHg. These same recommendations can be applied to those 18 years or older with chronic kidney disease and to those 18 years or older with diabetes.
- In the general non-black population, including those with diabetes, first line anti-hypertensives can include a thiazide diuretic, CCB, ACEi or ARB. In the general black population, initial anti-hypertensive treatment should include a thiazide diuretic or CCB.
- In those 18 years and older with CKD, initial therapy should include an ACEi or ARB to improve kidney outcomes.
The full recommendations can be found here:
http://jama.jamanetwork.com/article.aspx?articleid=1791497
Dr. Monica Gupta is a 2nd year internal medicine resident at NYU Langone Medical Center
Image courtesy of Wikimedia Commons