However, a serious discrepancy exists between these 2 sets of guidelines on the level of bp. Revisiting the jnc 7 recommendations jeffery martin, m. Among the elderly, isolated systolic hypertension ish is predominant in comparison to diastolic or combined hypertension. Joint national committee 8 jnc 8 guidelines for management. The jnc 7 categorized stage 1 hypertension as a bp of 1401599099 mm hg and recommended 14090 mm hg as the threshold for initiation of antihypertensive drug therapy in the general adult population and 80 mm hg or higher for patients with diabetes or ckd. The seventh report of the joint national commi ttee on. In both the jncv and jncvi, there was a recommendation that all such persons 26. Reference card from the seventh report of the joint national.
Introduction n present scenario one of the most common condition. Patients are categorized according to age and the presence of diabetes dm orand chronic kidney disease ckd. What new evidence supported changing the bp cutoff for hypertension to 80 mm hg. In 2018 the escesh published a guideline which retains the 14090 threshold definition of hypertension, including for patients with chronic kidney disease ckd, and emphasizes lifestyle interventions as primary treatment, with consideration of antihypertensive drug therapy only in adults at very high risk, eg with established cvd. Jnc 8 update on hypertension guidelines alan cementina, md associate clinical professor family medicine center at asylum hill. Those with diabetes mellitus dm and chronic renal insufficiency cri are at higher risk for complications. How joint national committee jnc 8 report is different from jnc 7. The committee recognizes that the responsible clinicians judgment of the individual patients needs remains paramount. Secondly, similar treatment goals have been defined for all hypertensive population and no distinction between uncomplicated hypertension and. Smoking cessation control blood glucose and lipids diet eat healthy i.
The jnc 7 panel recommended that after an initial high blood pressure reading, followup with a confirmatory blood pressure reading should occur within 7 days to 2 months, depending on how high the initial reading was and whether or. All individuals with clinical evidence of overt target organ damage table iv or cvd are included in this category, as well as those who have. Jnc 5 proposed a new classification system for hypertension. Lifestyle modification physical exercise, weight reduction, salt restriction.
Secondary hypertension the primary care perspective stephen koesters, md assistant professor of clinical medicine department of pediatrics division of general medicine the ohio state universitys wexner medical center what is hypertension jnc 7. Hypertension guidelines 1977 jnc 1 1980 jnc 2 1984 jnc 3 1988 jnc 4 1993 jnc 5 1997 jnc 6 2003 jnc 7 delayed waiting for allhat. While we were waiting for jnc 8, the american society of hypertension ash in collaboration with the international society of hypertension released their own expert opinion piece aimed at prescribers. According to the jnc, the decision to treat with medications depends on the overall risk and the degree of hypertension. The therapeutic guidelines of the research group for longterm prognosis of hypertension in the elderly were published in japan in 1999. Pdf prescribing pattern of antihypertensive drugs and. Mengingat bahwa hipertensi merupakan suatu penyakit kronis yang memerlukan terapi jangka panjang dengan banyak komplikasi yang mengancam nyawa seperti infark miokard, stroke, gagal ginjal, hingga kematian jika tidak dideteksi dini dan diterapi dengan tepat. Elderly patients who have been diagnosed with hypertension as per jnc7 guidelines and. Jnc 7 hypertension reference card absolute total care.
The new american college of cardiologyamerican heart association accaha hypertension guideline upends this consensus by redefining hypertension as a. Joint national committee jnc guidelines for hypertension. Chlorthalidone recommended over hctz, but preeminence as first line therapy might be challenged. The 2017 guideline on management of high blood pressure in adults. The jnc vii issued guidelines that ish is a more important risk factor. Jnc 8 hypertension guideline algorithm initial drugs of. The eighth joint national committee jnc 8 the new guideline has simpli.
The new jnc 8 guidelines, which were published in december of 20, displace the prior report of jnc 7. Classification of blood pressure the seventh report of the. Pdf the seventh report of the joint national committee on. Firstly, the definitions of hypertension and prehypertension, which were welldefined in jnc 7 has not been addressed in jnc 8. Reference card from the seventh report of the joint. The 20 joint european society of hypertension esh and the european society of cardiology esc guidelines recommend that ambulatory bloodpressure monitoring abpm be incorporated into the assessment of cardiovascular risk factors and hypertension. Worldwide prevalence estimates for htn may be as much as 1 billion. Management of hypertension 2015 georgia chapter acp scientific meeting john j.
That partnership fell through as well, so when the jnc 8 panel members guideline was published in the journal of the american medical association, it. Jnc 6 and other nhbpep clinical guidelines was selected. National committee on prevention, detection, evaluation, and treatment of high. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7. The 2017 guideline on management of high blood pressure in. Department of health and human services national institutes of health national heart, lung, and blood institute. The sixth report of the joint national committee on. Jnc 8 and more hypertension guidelines from the eighth joint national committee jnc 8 are finally here. While jnc 8 suggests treating patients with both diabetes and hypertension to a blood pressure goal jnc 8 guideline authors simplified a complicated recommendation for followup in patients with hypertension. Algorithm for treatment of hypertension reference card from the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal jnc 7 stage 2 hypertension usually have sustained resting bp levels 140. Below is a summary of the most recent national guidelines for evaluating these patients, and the figure shows the bp classification by the eighth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 8 1 and 2017 american college of cardiologyamerican heart association aha. These guidelines have been formulated by adopting an evidencebased approach and recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Since the publication of the sixth report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure jnc vi released in 1997,1 many largescale clinical trials have been published. Optimize dosages or add additional drugs until goal blood pressure is achieved.
Hypertension unspecified icd 10 icd10 code for secondary hypertension, unspecified i15. Problem magnitude 35 million office visits are as the primary diagnosis of htn. Treatment recommendations for hypertension as outlined in the sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc vi are constantly evolving and being refined as new information on the disease becomes evident. Detection, evaluation, and treatment of high blood pressure jnc 7.
I am concerned that the prehypertension classification in the jnc 7 guidelines 1 threatens to medicalize most of the adult population. Using jnc 7 as a point of departure, an editorialist argues that hypertension control will improve only with substantial changes in the delivery of chronicdisease care and in how the public views lifestyle changes. Making sense of the us hypertension guideline in 2018. Jnc 8 hypertension guideline algorithm lifestyle changes. Reduced role for betablockers as initial therapy still pre eminent for hfref and cad, particularly atenolol. Jnc 8 bp target of 80 yrs hypertension in the very elderly trial. Eduardo hernandezvila, md hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure. Pada tahun 20, joint national committee 8 telah mengeluarkan guideline terbaru mengenai tatalaksana hipertensi atau tekanan darah tinggi. Hypertension course ceufast nursing continuing education. Jnc 7 suggests that all people with hypertension stages 1 and 2 be treated. Jnc 7 is the last attempt to bridge the big gap between the current availability of potent. Prescribing pattern of antihypertensive drugs and adherence to jnc vii guideline. The seventh report of the joint national committee on the.
Hypertension htn, also known as high blood pressure bp, affects millions of people. Jnc 7 is the last attempt to bridge the big gap between the current availability. The new jnc vii and eshish hypertension recommendations. May 30, 2003 using jnc 7 as a point of departure, an editorialist argues that hypertension control will improve only with substantial changes in the delivery of chronicdisease care and in how the public views lifestyle changes. The eighth joint national committee guidelines jnc 8. Prior guidelines set blood pressure goals lower for those with dm or cri, but the newest guidelines from the joint national committee the eighth joint national committee jnc 8 recommend that those with dm andor cri should have a blood pressure goal of 14090 mm hg or lower. 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. Young women with blood pressures of 12080 mm hg are at very low absolute risk of adverse cardiovascular events. Based in part on the results of clinical trials, jnc 5 also emphasized the importance of systolic hypertension. Algorithm for treatment of hypertension reference card from the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal jnc 7 chair because, like his predecessors, he is well versed in hypertension, yet independent of these major studies. Nine trials contributed to the accaha metaanalysis on. Treatment of high blood pressure jnc 7 was based on 4 factors. Pdf jnc 8 hypertension guideline algorithm witri chan. Betablockers are no longer considered as firstline drugs, according to jnc 8 guidelines for hypertension.
While jnc 8 suggests treating patients with both diabetes and hypertension to a blood pressure goal vii. Algorithm for treatment of hypertension reference card from the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal vii. Classification of blood pressure the seventh report of. Explore jnc 8 hypertension guidelines from jama network. 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. Dec 05, 2017 this jama clinical guidelines synopsis summarizes the 2017 american college of cardiologyamerican heart association guideline on prevention, detection, evaluation, and management of high blood pressure in adults.
Validity of the jnc vi recommendations for the management. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7, 2003 2. Hypertension is an easily diagnosed and potentially easily treated problem. Jnc 8 guidelines for the management of hypertension in adults. In 2003, the joint national committee on prevention.
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