Although most of us may not be aware of it, hypertension (HTN) is the most common condition seen in primary care situations, and is a major risk factor for heart attack, stroke, kidney failure and death. Over the past twenty years, the definition of HTN as in how high it must be to warrant treatment has gradually been lowered by successive conclaves of experts, known as the JNC (Joint National Commissions) on Hypertension. But the last such advisory, JNC-7, was published under the auspices of the NIH in 2003. The NIH declined to revise the guidelines, so the JNC-8 expert panel decided to take the bull by the horns and publish their opinions themselves, in JAMA.
That s how these new guidelines for managing HTN have just been published in the Journal of the American Medical Association. A product of a panel appointed to the Eighth Joint National Committee, these guidelines are based on the results of randomized controlled trials that reported the effects of HTN interventions on overall mortality, or that due to cardiovascular disease, or chronic kidney disease.
Unlike earlier guidelines, the current ones do not redefine HTN, but they do define thresholds for treatment of the condition. For individuals over 60, the panel found strong evidence to support treating to attain a blood pressure of less than 150/90 which represents a turnabout, since this level is higher than previously recommended. For younger patients, they recommend treating to a goal BP of less than 140/90. This latter goal is also recommended for patients with diabetes or chronic kidney disease.
In addition to defining thresholds for treatment, the panel also provided information about which medications are best for initiating HTN treatment. They emphasized The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug.
Since many people are unaware that they have HTN, ACSH s Dr. Gilbert Ross advises, it is crucial that physicians measure blood pressure at each visit, and initiate treatment as indicated in the guidelines. If HTN is controlled the many unfortunate sequelae can be either avoided or postponed.