Clinical Question

What are the best methods to prevent, detect, evaluate, and treat hypertension?

Bottom Line

See the Synopsis section for a summary of the updated hypertension treatment recommendations from the Eighth Joint National Committee (JNC 8). (Level of Evidence = 1a)

Synopsis

Recommendations for target goals: (1) For the general population, 60 years or older, the goal is to treat to a systolic blood pressure of less than 150 mm Hg and a diastolic blood pressure of less than 90 mm Hg. (2) For the general population, younger than 60 years, the goal is to treat to a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 90 mm Hg. (3) In adults 18 years or older with chronic kidney disease—defined as an estimated or measured glomerular filtration rate less than 60 mL per minute per 1.73 m² in individuals younger than 70 years—and in patients at any age with albuminuria (> 30 mg of albumin per g of creatinine), treat to a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 90 mm Hg. (4) In adults 18 years or older with diabetes mellitus, treat to a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 90 mm Hg.

Recommendations for drug choice: (1) In the general nonblack population, including patients with diabetes, the appropriate initial choice is a thiazide diuretic (any type, including hydrochlorothiazide or chlorthalidone), calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB). Initial treatment with a thiazide diuretic is most effective in improving heart failure outcomes. Beta blockers and alpha blockers are not recommended for initial treatment. (2) In the general black population, including those with diabetes, the appropriate initial choice is a thiazide diuretic or calcium channel blocker. (3) In adults 18 years or older with chronic kidney disease, the appropriate initial choice is an ACE inhibitor or an ARB. In black patients with chronic kidney disease without proteinuria, the initial choice is less clear and can be a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB. (4) Do not use an ACE inhibitor and an ARB together.

Study design: Practice guideline

Funding source: Foundation

Setting: Various (guideline)

Reference: JamesPAOparilSCarterBLet al2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA.2014; 311( 5): 507– 520.