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2014 Evidence-Based Guidelines

for the Management of High


Blood Pressure in Adults
Compiled by : Chandra Permana

Lecturer : dr. Suryono, Sp. JP FIHA

This hypertension guideline focuses on 3 questions related to high blood pressure
(BP) management. They address thresholds, goals for pharmacologic treatment,
and whether particular antihypertensive drugs or drug classes improve important
health outcomes compared to others.
1. In adults with hypertension, does initiating antihypertensive pharmacologic therapy
at specific BP thresholds improve health outcomes?
2. In adults with hypertension, does treatment with antihypertensive pharmacologic
therapy to a specified BP goal lead to improvements in health outcomes?
3. In adults with hypertension, do various antihypertensive drugs or drug classes
differ in comparative benefits and harms on specific health outcomes?
The answers to these three questions are reflected in 9 recommendations
Recommendation 1
(Strong recommendation)




Recommendation 2
(Strong recommendation)



General population
60 years
SBP 150 mm Hg
or DBP 90 mm Hg
SBP <150 mm Hg
and DBP <90 mm Hg
General population
<60 years
DBP 90 mm Hg DBP <90 mm Hg
Goals BP thresholds
Recommendation 4
(Expert opinion)
Population with CKD
18 years
SBP 140 mm Hg
or DBP 90 mm Hg
SBP <140 mm Hg
and DBP <90 mm Hg
Goals
BP thresholds
CKD: chronic kidney disease
Recommendation 3
(Expert opinion)
General population
<60 years
SBP 140 mm Hg SBP <140 mm Hg
Recommendation 5
(Expert opinion)





Recommendation 6
(Moderate recommendation)
Population with diabetes
18 years
SBP 140 mm Hg
or DBP 90 mm Hg
SBP <140 mm Hg
and DBP <90 mm Hg
General nonblack
population (with diabetes)
Thiazide-type diuretic,
calcium channel blocker (CCB),
angiotensin-converting enzyme inhibitor (ACEI),
or angiotensin receptor blocker (ARB)
Initial treatment
Goals
BP thresholds
Recommendation 7
(Moderate recommendation)



Recommendation 8
(Moderate recommendation)


General (with diabetes)
black population
Thiazide-type diuretic,
or calcium channel blocker (CCB)
Population with CKD 18
years
Angiotensin-converting enzyme inhibitor (ACEI),
or angiotensin receptor blocker (ARB)
Initial treatments
Initial or add-on treatments
Recommendation 9
(Expert opinion)
Goal BP not reached
within a month of treatment
Increase the dose of the initial drug,
or add a second drug (from the list provided)
Goal BP not 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
Non control strategies

This JNC8 guideline has not redefined high BP, and considers the
140/90 mm Hg definition from JNC 7 reasonable.
It offers clinicians an analysis of what is known and not known
about BP treatment thresholds, goals, and drug treatment
strategies to achieve those goals.
However these recommendations are not a substitute for clinical
judgment, and decisions about care must carefully consider and
incorporate the clinical characteristics and circumstances of
each individual patient.

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