2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

James PA1, Oparil S2, Carter BL1, Cushman WC3, Dennison-Himmelfarb C4, Handler J5, Lackland DT6, LeFevre ML7, MacKenzie TD8, Ogedegbe O9, Smith SC Jr10, Svetkey LP11, Taler SJ12, Townsend RR13, Wright JT Jr14, Narva AS15, Ortiz E16.

Author information

Erratum in

JAMA. 2014 May 7;311(17):1809.

Abstract

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

Comment in

Assessing the trustworthiness of the guideline for management of high blood pressure in adults. [JAMA. 2014]
Guidelines for managing high blood pressure. [JAMA. 2014]
Guidelines for managing high blood pressure. [JAMA. 2014]
Guidelines for managing high blood pressure--reply. [JAMA. 2014]
Recommendations for treating hypertension: what are the right goals and purposes? [JAMA. 2014]
Updated guidelines for management of high blood pressure: recommendations, review, and responsibility. [JAMA. 2014]
Guidelines for managing high blood pressure. [JAMA. 2014]
The new cholesterol and blood pressure guidelines: perspective on the path forward. [JAMA. 2014]
[The US-American Hypertension Guideline 2014: JNC 8]. [Dtsch Med Wochenschr. 2014]

PMID:: 24352797; [PubMed - indexed for MEDLINE]

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National Guideline Clearinghouse | 2014 evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

Joint National Committee

Guideline Title

2014 evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

Bibliographic Source(s)

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. [45 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. 2003 May 21;289(19):2560-71. [81 references]