Joint National Committee (JNC) Guidelines For Hypertension

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-blockersNo 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.

Comparison of JNC-VII & JNC-VIII guidelines:

Criteria

JNC-VII guidelines

JNC-VIII guidelines

Goal BP for < 60 years without CKD or DM < 140/90 < 140/90
Goal BP for > 60 years without CKD or DM < 140/90 < 150/90
Goal BP for any age with CKD or DM or both < 130/80 < 140/90
First choice drug without compelling

indications

Thiazides Thiazides, ACE

inhibitors, ARBs, CCBs

First-line drugs Thiazides, beta-blockers,

ACEI, ARB, CCB

Thiazides, beta-blockers,

ACEI, ARB, CCB

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.

Exam Important

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

  • Revisions in JNC 8 guidelines include first-line drugs as Thiazide, ACE inhibitors, ARBs & calcium channel blockers (CCBs).
  • Beta-blockers are no longer considered as first-line drugs, according to JNC 8 guidelines for hypertension.
  • ACE inhibitors/ARBs are first choice drugs in patients with CKD irrespective of ethnic backgrounds.
  • For African descent patients without CKD, calcium channel blockers or thiazides are preferred.
  • Goal for all patients < 60 years, BP should be < 140/90 mmHgirrespective of presence or absence of diabetes (DM) or chronic kidney disease (CKD).
  • Goal for elderly > 60 years without CKD or DM or both, BP is targeted at < 150/90 mm/Hg.
  • Goal for elderly > 60 years with CKD or DM or both, BP is targeted at < 140/90 mmHg.

 

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