Tag: Joint National Committee (JNC) Guidelines For Hypertension

Joint National Committee (JNC) Guidelines For Hypertension

JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION

Q. 1

Management of uncomplicated essential hypertension is:

 A

No need to treat

 B

Diet modification and exercise

 C

Diet modification, exercise & drugs

 D

Drugs alone

Q. 1

Management of uncomplicated essential hypertension is:

 A

No need to treat

 B

Diet modification and exercise

 C

Diet modification, exercise & drugs

 D

Drugs alone

Ans. C

Explanation:

Answer is C (Diet modification, exercise & drugs)

Management of uncomplicated essential hypertension includes health promoting lifestyle modifications (includes dietry modification & exercise) and pharmacological therapy (drugs).

Management of Uncomplicated Essential Hypertension

Lifestyle modification

Weight

reduction

Attain and maintain BMI <25 kg/m2

Dietary salt

reduction

<6 g NaCl/d

Adapt DASH-

Diet rich in fruits, vegetables, and low-fat

type dietary plan

dairy products with reduced content of

saturated and total fat

Moderation of

For those who drink alcohol, consume 2

alcohol

drinks/day in men and I drink/day in

consumption

women

Physical activity

Regular aerobic activity, e.g., brisk

walking for 30 min/d






 
 
 
 
 
 
 
 
 
 
 
Pharmacological Therapy
  • In uncomplicated essential hypertension the treatment is started with a low-dose thiazide (hydrochlorothiazide 12.5-25 mg per day), an ACE inhibitor or a beta-blocker.
  • Calcium-channel blocker can be used as the first-line treatment if the systolic pressure is high.
  • Angiotensin-II receptor antagonists should be considered when the adverse effects of ACE inhibitors or other drugs have proven problematic.
  • If no response is achieved, or adverse effects emerge, a
    product of another drug group should be prescribed.
  • Combination therapy is started if desired blood pressure reduction is not achieved with monotherapy.
  • The reasons behind poor response must be established.

Q. 2

A = ACE inhibitor, B = beta blocker, C = calcium channel blocker, D= diuretics. For elderly with hypertension antihypertensive drug of choice is ‑

 A

A or D

 B

A or B

 C

A or C

 D

C or D

Q. 2

A = ACE inhibitor, B = beta blocker, C = calcium channel blocker, D= diuretics. For elderly with hypertension antihypertensive drug of choice is ‑

 A

A or D

 B

A or B

 C

A or C

 D

C or D

Ans. D

Explanation:

Ans. is ‘d’ i.e., C or D

Pharmacological treatment of hypertension

Indications of drug therapy (the British hypertension society guidelines).

When sustained BP exceeds 160/100 mmHg or.

When BP is in the range of 140-159 / 90-99 mmHg and there is target organ damage or cardiovascular disease.

For diabetics when BP exceeds 140/90 mmHg.

The optimal target is to lower BP to or below 140/85 mmHg in nondiabetics and 140/80 mmHg in diabetics (WHO target is 130/85 mmHg).

Drug therapy

A simple stepped AB/CD regimen is used.

Quiz In Between



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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