New Hypertension Guidelines Emphasize Less Stringent Thresholds — Physician’s First Watch

Medical News |
December 19, 2013

New Hypertension Guidelines Emphasize Less Stringent Thresholds

By Kelly Young

New hypertension guidelines from panel members of the Eighth Joint National Committee (JNC 8) recommend looser blood pressure treatment thresholds for older adults. The guidelines, published in JAMA, update JNC 7 recommendations from over a decade ago.

Drawing from randomized controlled trials, the group recommends that adults aged 60 and older should receive antihypertensive medications if their systolic BP is 150 mm Hg or higher or their diastolic BP is 90 or higher. This is a departure from previous recommendations.

Younger adults should begin drug treatment if their systolic BP is 140 or higher or their diastolic BP is 90 or higher. The 140/90 threshold applies to adults with chronic kidney disease or diabetes as well, also a change.

In nonblack patients, initial drug treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme (ACE) inhibitor, or angiotensin-receptor blocker (ARB). For black patients, treatment should start with a thiazide-type diuretic or CCB. In adults with CKD, therapy should include an ACE-inhibitor or ARB.

Lifestyle interventions are still recommended for all patients. The guideline features an algorithm to guide physicians through treatment options.

Editorialists note that despite previous recommendations to target systolic BP below 140 mm Hg, only about half of Americans with hypertension are below this level. They hint that raising the threshold to 150 in older adults could potentially have significant public health consequences.

Reader Comments (13)

MIGUEL GAMBETTA Physician, Cardiology, Office,

Yes, they are easier to follow, less pressure to reach the target guidelines, very likely better compliance, lesser number of pills, lower cost, but what about long term outcomes?

adel mahmoud Resident, Infectious Disease, saudi arabia

very good and it is helpfull

B Rajan Medical Student

Excited about JNC 8...

moamin Physician, Cardiology

new JNC 8 guidelines make me more comfortable as its become less aggressive than before ( even than last European one ) but i have some concerns regarding the role of ambulatory BP ( where is it from guidlines) and what about the prehypertension as a term , dose it still working or not.

EDGAR PALACIOS Physician, Critical Care Medicine

very good

Leigh Naftolin MD Physician, Family Medicine/General Practice, Retired (locum Tennens)

I have followed these apparent NEW guidelines. The past guidelines were difficult to meet,and the patients were reluctant to change their current meds because they were controlled well with them. Of course if they had other NEW issues they were willing to make appropriate med changes.

Ahmed Foaud Physician, Menofiya University

New Guidelines Equal Better Health

Rajesh Rawal

Hi this is great help.

kapil upadhyay Physician, Internal Medicine, Lucknow, India


dks subrahmanyam Physician, Internal Medicine, jipmer,puducherry,india

one size does not suit all is well known.BP control has to be individualized and those with early TOD indicating long standing hypertension should have their pressure brought to target in staged manner over longer periods of time.

ziauddin Medical Student, Cardiology, pakistan PIMs

why we cant strat frm beta blocker ? as this is nt agud choice

bhanu chalise Medical Student

i also like to know about new protocols

mohammed abdalrhman Resident, Internal Medicine, saudia

Good but what about white coat syndrome

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