Dbp is 90 to 99 mm hg stage 2sbp is equal to or more than 160 mm hg. Hypertension 101 jared moore, md, facp assistant program director, internal medicine residency clinical assistant professor of internal medicine division of general medicine the ohio state university wexner medical center objectives 1. Blood pressure was defined and classified according to the jnc 7 report as normal, prehypertension, stage 1, and stage 2 hypertension. Dbp is 80 to 99 mm hg stage 1sbp is 140 to159 mm hg. The jnc 8 panel confirms that the 14090 mmhg definition for hypertension from the jnc 7 report remains the standard for diagnosis for individuals who do not have additional comorbidities.
Clinical practice guidelines for the management of hypertension in the community. Jnc 8 hypertension guideline algorithm lifestyle changes. This cohort study assesses whether longterm variability and rate of change of blood pressure from young adulthood to midlife are associated with cardiovascular disease and allcause mortality by middle age. Jnc 8 guidelines for the management of hypertension in adults author. Overt cvd untreated individuals with ash stage 3 hypertension jnc 7 stage 2 hypertension usually have sustained resting bp levels 140. The eighth joint national committee guidelines jnc 8 published in 2014 provides evidence based recommendations for management of hypertension and is an important reference for clinicians. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials.
Jnc 7, not the focused jnc 8 2014 guideline reclassification of high blood pressure bp treatment thresholds and ascvd risk. The new guidelines emphasize control of systolic blood pressure sbp and diastolic blood pressure dbp with age and comorbidityspecific treatment cutoffs. Detailed summary from the 2017 guideline for the prevention. The joint national committee jnc released htn guidelines, most recently jnc 8 in 2014. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd. Joint national committee 8 jnc 8 guidelines for management. Detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal guidelines. In addition, roughly half of hypertensive individuals do not have adequate blood pressure control.
Patients will be asking about the new joint national committee jnc 8 hypertension guidelines, which were published in the journal of the american medical association on december 18. Carrie armstrong, afp senior associate editor subject. Compared with previous hypertension treatment guidelines, the joint national committee jnc 8 guidelines advise. New accaha hypertension guidelines make the new 140. Joint national committee jnc guidelines for hypertension. The new guidelines also introduce new recommendations. Since the first report of the joint national committee jnc on detection, evaluation, and treatment of high blood pressure was published in 1976, six updated reports were commissioned and published by the national heart, lung, and blood institute nhlbi, with the last, jnc 7, published in 2003. For stage 2, the recommendation is 2 bplowering medications in addition to healthy lifestyle changes, which is a more aggressive treatment standardprevious guidelines. The jnc 7 executive committee and writing teams were selected entirely from the nhbpep cc because they. Jnc 8 guidelines offer greater discretion in drug choice and modest. Jnc 8 takes a rigorous, evidencebased approach to recommend when to treat, goals of treatment, and medications in the management of hypertension in adults. Adults with stage 2 hypertension should be evaluated by or referred to a primary care physician within one month, receive a combination of nonpharmacologic interventions and bplowering.
In 2014, the eighth joint national committee jnc 8 published the. The jnc 8 guidelines move away from the assumption that lower blood pressure levels will improve outcomes regardless of the type of agent used to achieve the lower level. The new guidelines differ from jnc 7 in some important ways. The jnc 7 executive committee and writing teams were selected entirely from the nhbpep cc because they are recognized as experts in their disciplines by their peers. The 2017 accaha guidelines eliminate the classification of prehypertension and divides it into two levels 1, 2. Smoking cessation control blood glucose and lipids diet eat healthy i. Impact of treating hypertension moser m, hebert pr. Important changes from the jnc 7 guidelines2 include the following. These were endorsed by the american college of physicians acp and american. Explore jnc 8 hypertension guidelines from jama network. Hypertension one of the most preventable contributors to disease and death decreases in blood pressure reduce adverse health outcomes blood pressure level mmhg category systolic diastolic normal jan 21, 2016 hypertension guidelines jnc 8 1.
Jnc 8 hypertension guideline algorithm initial drugs of. Aafp continues to endorse the 2014 evidencebased guideline for the management of high blood pressure in adults, developed by panel members appointed to the eighth joint national committee jnc 8. Lifestyle modification physical exercise, weight reduction, salt restriction. Who is rightthe us or europeregarding how to manage hypertension. Although the nih ultimately withdrew from the guideline development process at a late stage in the development of jnc 8, the panel decided. Stage 2 hypertension blood pressure should be based on an average of. Comparison between jnc 7 and jnc 8 jnc 7 blood pressure classification7 blood pressure systolic blood pressure mmhg diastolic blood pressure mmhg normal hypertension 1209 or 8089 stage 1 hypertension 140159 or 9099 stage 2 hypertension 160 or 100.
Reference card from the seventh report of the joint national. Hypertension is one of the most common conditions seen in primary care and optimal management of hypertension is an important intervention in prevention of stroke, myocardial infarction, renal failure and death. The seventh report of the joint national committee on. If patient is hypotensive when standing but has mild hypertension. Hypertension one of the most preventable contributors to disease and death decreases in blood pressure reduce adverse health outcomes blood pressure level mmhg category systolic diastolic normal 180110 mm hg definition of high blood pressure not redefined in eighth joint national committee jnc 8 2014 guidelines for management of high blood pressure in adults 1. Jnc 7 and 8 reports provide guidelines for blood pressure management and treatment. The global prevalence of hypertension is high, and among nonpregnant adults in the united states, treatment of hypertension is the most common reason for office visits and for the use of chronic prescription medications. Jnc 8 guidelines for the management of hypertension in adults.
Worldwide prevalence estimates for htn may be as much as 1 billion. Aram chobanian was selected as the jnc 7 chair because, like his predecessors, he is well versed in hypertension, yet independent of these major studies. More than 2 decades have passed since the publication of the jnc 7 guidelines. The eighth joint national committee guidelines jnc 8.
Patients will be asking about the new jnc 8 hypertension guidelines, which. May 25, 2007 persons with either stage 1 or stage 2 hypertension have the same bp targets. Reference card from the seventh report of the joint. Problem magnitude 35 million office visits are as the primary diagnosis of htn. The jnc8 panel confirms that the 14090 mmhg definition for hypertension from the jnc 7 report remains the standard for diagnosis for individuals who do not have additional comorbidities.
Instead, the jnc 8 guidelines encourage use of agents with the best evidence of reducing cardiovascular risk. The eighth joint national committee jnc 8 the new guideline has simpli. New guidelines endorsed by 11 organizations lower the threshold for stage 1 hypertension to include adults with systolic pressure from to 9 mm hg or 80 to 89 mm hg diastolic. Treating stage 2 hypertension giles 2005 the journal of. By definition blood pressure refers to the force exerted on vessel walls when blood is flowing in the arteries. State 2 hypertension represents a classification of hypertension development that comes after the advancement of stage 1 hypertension. Detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal jan 21, 2014 the jnc 8 hypertension guidelines. Including stage 2 hypertension definition, symptoms, treatment, diet and dangers. A 3rd drug should be added if the goal is not achieved with 2 drugs. Mar 15, 2018 adults with stage 2 hypertension should be evaluated by or referred to a primary care physician within one month, receive a combination of nonpharmacologic interventions and bplowering.
Explore the latest in hypertension, including the epidemiology, prevention, treatment, and longterm outcomes of high blood pressure. Stage 2 hypertension diet symptoms treatment dangers. Stage 1 hypertension 140159 9099 stage 2 hypertension. Below 50 years of age, males had a higher progression rate, particularly from normal to prehypertension, than females. Comparison between jnc7 and jnc8 jnc7 blood pressure classification7 blood pressure systolic blood pressure mmhg diastolic blood pressure mmhg normal 160 or 100. Jnc7 and 8 reports provide guidelines for blood pressure management and treatment. Stage 2 hypertension stage 2 hypertension blood pressure should be based on an average of. Understand the approach to the diagnosis and evaluation of. Stage 1 hypertension 140159 or 9099 confi rm within 2 months stage 2 hypertension.