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The panel anticipates that an objective assessment of this report following publication will allow open dialogue jnc 8 blood pressure guidelines pdf download endorsing entities and encourage continued attention to rigorous methods in guideline development, thus raising the standard for future guidelines. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Coronary revascularization includes coronary artery bypass surgery, coronary angioplasty and coronary stent placementother revascularization includes carotid, renal, and lower extremity revascularization.
Effect of antihypertensive treatment on stroke recurrence. Purchase access Subscribe to the journal. Personalize the information you receive by selecting targeted content and special offers. Accessed November 4, We hope that the algorithm will facilitate implementation and be useful to busy clinicians. Abundant evidence from randomized controlled trials RCTs has shown benefit of antihypertensive drug treatment in reducing important health outcomes in persons with hypertension.
The jnc 8 blood pressure guidelines pdf download statements supporting the recommendations are in the online Supplement. N Engl J Med. PubMed Google Scholar Crossref. Managing Hypertension Part 1: Telmisartan, ramipril, or both in patients at high risk for vascular events. The commonly used estimating equations for GFR were not developed in populations with significant numbers of people older than 70 years and have not been validated in older adults. The following recommendations are based on the systematic evidence review described above Box.
Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes jnc 8 blood pressure guidelines pdf download patients with type 2 diabetes mellitus the ADVANCE trial: What Do I Need to Know? Let us know by voting in our online poll. Three trials that met our criteria for review addressed the effect of antihypertensive drug therapy on change in GFR or time to development of ESRD, but only one trial addressed cardiovascular disease end points.
Finally, panel members point out that in specific situations, one antihypertensive drug may be replaced with another if it is perceived not to be effective or if there are adverse effects. The strong evidence base of this report should inform quality measures for the treatment of patients with hypertension. In addition, the ability to compare studies from different time periods was limited by differences in clinical trial design and analytic techniques.
Although adverse effects and harms of antihypertensive treatment documented in the RCTs were considered when the panel made its decisions, the review was not designed to determine whether therapy-associated adverse effects and harms resulted in jnc 8 blood pressure guidelines pdf download changes in important health guiddlines.
Sign in to customize your interests Sign in to your personal account. The relatively high threshold of participants was used because of the markedly lower event rates observed in recent RCTs such as ACCORD, suggesting that larger study populations are needed to obtain interpretable results. Further, the diagnostic criteria for CKD do not consider age-related decline in kidney function as reflected in estimated GFR.
The JNC 8 Hypertension Guidelines: An In-Depth Guide
Randomized controlled trials that included participants with normal BP were excluded from our formal analysis. Blood Pressure Lowering in Type 2 Diabetes: Recommendations 1 through 5 address questions 1 and 2 concerning thresholds and goals for BP treatment. Hypertension-Stroke Cooperative Study Group. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension.
Accessed October 28, Panel members disclosed any potential conflicts of interest including studies evaluated in this report and relationships with industry. Which Ones Are Making an Impact? Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients JATOS.
Explore JNC 8 Hypertension Guidelines from The JAMA Network
Purchase access Subscribe now. The panel limited the inclusion criteria of this second search to the following.
Clinical outcomes by race in hypertensive patients with and without the metabolic syndrome: Recommendation 3 is based on expert opinion. Moderate Recommendation — Grade B. Accessed November 6, Use of a consistent BP goal in the general population younger than 60 years and in adults with diabetes of any age may facilitate guideline implementation. Once all evidence statements for each critical question were identified, the panel reviewed the evidence statements to craft the clinical recommendations, voting on each recommendation and on the strength of the recommendation Table 3.
There is also evidence albeit low jnc 8 blood pressure guidelines pdf download from evidence statement 6, question 2 that setting a goal SBP of lower than mm Hg in this age group provides no additional benefit compared with a higher goal SBP of to mm Hg or to mm Jnc 8 blood pressure guidelines pdf download.