Jnc 8 Classification Of Hypertension

Explore Jnc 8 Hypertension Guidelines From Jama Network

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

HISTORY OF JNC GUIDELINES:

Older JNC guidelines:

JNC VI :
- Hypertension was classified into borderline, stage 1, 2 & 3.
JNC VII:
- Includes pre-hypertension, stage 1 & 2.
- Target blood pressure goal (according to JNC VII) – 140/90 mm Hg for all, except patients with diabetes, chronic renal disease & BP below 130/80 mm Hg.
- Life-style modification (physical exercise, weight reduction, salt restriction).
- Unhealthy lifestyle – Thiazides diuretics (if not contraindicated).
JNC VII – BP classification

Blood pressure Classification	SBP (mm Hg)	DBP (mm Hg)
Normal	< 120	< 80
Pre-hypertension	120-139	80-89
Stage I Hypertension	140-159	90-99
Stage II Hypertension	≥ 160	≥ 100

SALIENT FEATURES OF JNC-8 GUIDELINES:

Goal for all patients < 60 years:
- BP should be < 140/90 mmHg, irrespective of presence or absence of diabetes (DM) or chronic kidney disease (CKD).
Goal for elderly > 60 years without CKD & DM:
Goal for elderly > 60 years with CKD or DM or both:

Revisions in JNC 8 guidelines:

First line drugs: Thiazide, ACE inhibitors, ARBs & calcium channel blockers (CCBs).
Beta-blockers – No longer considered as first-line drugs.
- Due to increased mortality.

Precautions for hypertensive drugs:

ACE inhibitors or ARBs – First choice drugs in patients with CKD irrespective of ethnic backgrounds.
- ACE inhibitors & ARBs should not be given simultaneously.
For African descent patients without CKD – CCBs or thiazides preferred.

Comparison of JNC-VII & JNC-VIII guidelines:

Criteria	JNC-VII guidelines	JNC-VIII guidelines
Goal BP for < 60 years without CKD or DM	< 140/90	< 140/90
Goal BP for > 60 years without CKD or DM	< 140/90	< 150/90
Goal BP for any age with CKD or DM or both	< 130/80	< 140/90
First choice drug without compelling indications	Thiazides	Thiazides, ACE inhibitors, ARBs, CCBs
First-line drugs	Thiazides, beta-blockers, ACEI, ARB, CCB	Thiazides, beta-blockers, ACEI, ARB, CCB

NOTE:

In 2013, National Heart, Lung, and Blood Institute announced that after JNC 8, no guidelines will be developed.
Instead, medical societies are encouraged to develop guidelines of their own.

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

Revisions in JNC 8 guidelines include first-line drugs as Thiazide, ACE inhibitors, ARBs & calcium channel blockers (CCBs).
Beta-blockers are no longer considered as first-line drugs, according to JNC 8 guidelines for hypertension.
ACE inhibitors/ARBs are first choice drugs in patients with CKD irrespective of ethnic backgrounds.
For African descent patients without CKD, calcium channel blockers or thiazides are preferred.
Goal for all patients < 60 years, BP should be < 140/90 mmHg, irrespective of presence or absence of diabetes (DM) or chronic kidney disease (CKD).
Goal for elderly > 60 years without CKD or DM or both, BP is targeted at < 150/90 mm/Hg.
Goal for elderly > 60 years with CKD or DM or both, BP is targeted at < 140/90 mmHg.