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

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.

Exam Important

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.

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