JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

HISTORY OF JNC GUIDELINES:

Older JNC guidelines:

JNC VI :

• Hypertension was classified into borderline, stage 1, 2 & 3.

JNC VII:

• Includes pre-hypertension, stage 1 & 2.
• Target blood pressure goal (according to JNC VII) – 140/90 mm Hg for all, except patients with diabetes, chronic renal disease & BP below 130/80 mm Hg.
• Life-style modification (physical exercise, weight reduction, salt restriction).
• Unhealthy lifestyle – Thiazides diuretics (if not contraindicated).

JNC VII – BP classification

Blood pressure Classification	SBP (mm Hg)	DBP (mm Hg)
Normal	< 120	< 80
Pre-hypertension	120-139	80-89
Stage I Hypertension	140-159	90-99
Stage II Hypertension	≥ 160	≥ 100

SALIENT FEATURES OF JNC-8 GUIDELINES:

Goal for all patients < 60 years:

• BP should be < 140/90 mmHg, irrespective of presence or absence of diabetes (DM) or chronic kidney disease (CKD).

Goal for elderly > 60 years without CKD & DM:

• < 150/90 mm/Hg

Goal for elderly > 60 years with CKD or DM or both:

• < 140/90 mmHg.

Revisions in JNC 8 guidelines:

• First line drugs: Thiazide, ACE inhibitors, ARBs & calcium channel blockers (CCBs).
• Beta-blockers – No longer considered as first-line drugs.
• Due to increased mortality.

Precautions for hypertensive drugs:

• ACE inhibitors or ARBs – First choice drugs in patients with CKD irrespective of ethnic backgrounds.
• ACE inhibitors & ARBs should not be given simultaneously.
• For African descent patients without CKD – CCBs or thiazides preferred.

NOTE:

• In 2013, National Heart, Lung, and Blood Institute announced that after JNC 8, no guidelines will be developed.
• Instead, medical societies are encouraged to develop guidelines of their own.

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