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Special Communication
February 5, 2014

2014 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)

Author Affiliations
  • 1University of Iowa, Iowa City
  • 2University of Alabama at Birmingham School of Medicine
  • 3Memphis Veterans Affairs Medical Center and the University of Tennessee, Memphis
  • 4Johns Hopkins University School of Nursing, Baltimore, Maryland
  • 5Kaiser Permanente, Anaheim, California
  • 6Medical University of South Carolina, Charleston
  • 7University of Missouri, Columbia
  • 8Denver Health and Hospital Authority and the University of Colorado School of Medicine, Denver
  • 9New York University School of Medicine, New York, New York
  • 10University of North Carolina at Chapel Hill
  • 11Duke University, Durham, North Carolina
  • 12Mayo Clinic College of Medicine, Rochester, Minnesota
  • 13University of Pennsylvania, Philadelphia
  • 14Case Western Reserve University, Cleveland, Ohio
  • 15National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
  • 16at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota
JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427
Abstract

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.

There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.

Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, 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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