This guideline focuses on answering 3 questions about managing high blood pressure: 1) whether starting treatment at specific blood pressure thresholds improves health outcomes, 2) whether treating to a specified blood pressure goal leads to better outcomes, and 3) whether different drug classes have varying benefits and risks. The answers are reflected in 9 recommendations that address treatment thresholds and goals for general, elderly, chronic kidney disease, and diabetic populations. The recommendations suggest initial treatments, increasing treatment if goals are not met, and adding additional drugs while avoiding combining ACE inhibitors and ARBs. While offering an analysis of treatment strategies, the guideline notes that clinical judgment must consider each patient's specific circumstances.
This guideline focuses on answering 3 questions about managing high blood pressure: 1) whether starting treatment at specific blood pressure thresholds improves health outcomes, 2) whether treating to a specified blood pressure goal leads to better outcomes, and 3) whether different drug classes have varying benefits and risks. The answers are reflected in 9 recommendations that address treatment thresholds and goals for general, elderly, chronic kidney disease, and diabetic populations. The recommendations suggest initial treatments, increasing treatment if goals are not met, and adding additional drugs while avoiding combining ACE inhibitors and ARBs. While offering an analysis of treatment strategies, the guideline notes that clinical judgment must consider each patient's specific circumstances.
This guideline focuses on answering 3 questions about managing high blood pressure: 1) whether starting treatment at specific blood pressure thresholds improves health outcomes, 2) whether treating to a specified blood pressure goal leads to better outcomes, and 3) whether different drug classes have varying benefits and risks. The answers are reflected in 9 recommendations that address treatment thresholds and goals for general, elderly, chronic kidney disease, and diabetic populations. The recommendations suggest initial treatments, increasing treatment if goals are not met, and adding additional drugs while avoiding combining ACE inhibitors and ARBs. While offering an analysis of treatment strategies, the guideline notes that clinical judgment must consider each patient's specific circumstances.
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.