Objectives Background Review JNC 8 Recommendations through
clinical cases Discuss concerns about JNC 8 Figure out how to apply
JNC 8 to your practice (hopefully)
Slide 3
Prevalence 1/3 of adults About 60 million hypertensives in the
US Most common chronic condition seen in primary care Most common
risk factor for heart attack and stroke Prevalence increases with
increasing age
Slide 4
Why worry? There is a strong relationship between blood
pressure and the risk of CV events, strokes and kidney disease The
risk is lowest at 115/75 and for each increase of 20 mm in SBP or
10 mm in DBP the risk of major CV event or stoke doubles Treatment
of hypertension has been shown to reduce risk of adverse CV
outcomes by 20-25% and stroke by 30- 40%
Slide 5
How are we doing? Not so good 2005-8 NHANES survey found only
46-51% of persons with HTN had their blood pressure controlled
Slide 6
JNC HISTORY JNC 1: published 1976 JNC 2: published 1980 JNC 3:
published 1984 JNC 4: published 1988 JNC 5: published 1992 JNC 6:
published 1997 JNC 7: published 2003 JNC LATE
Slide 7
Slide 8
Questions Addressed by the JNC 8 Panel 1. In adults with
hypertension, does initiating antihypertensive pharmacologic
therapy at specific BP thresholds improve health outcomes?
Thresholds 2. In adults with hypertension, does treatment with
antihypertensive pharmacologic therapy to a specified BP goal lead
to improvement in health outcomes? Targets 3. In adults with
hypertension, do various antihypertensive drugs or drug classes
differ in comparative benefits and harms on specific health
outcomes? Impact of drugs
Slide 9
The 9 Recommendations Recommendations 1-5 address thresholds
and goals for BP treatment. Recommendations 6-8 address selection
of antihypertensive drugs. Recommendation 9 is a summary of
strategies based on expert opinion for starting and adding
antihypertensive drugs.
Slide 10
Case #1 A 72 yo Caucasian man with HTN, COPD, BPH and a history
of prostate cancer s/p radical prostatectomy presents for routine
f/u. He feels well except for SOB with heavy exertion that responds
to his albuterol inhaler. His BP is 118/78. He is currently on
albuterol MDI prn, Lisinopril 10 mg qday, and HCTZ 12.5 mg qday.
His labs are unremarkable. What should you do with his hypertensive
regimen?
Slide 11
RECOMMENDATION 1 In the general population aged 60 years,
initiate pharmacological treatment to lower BP at SBP of 150 mm Hg
or DBP of 90mm Hg and treat to a goal SBP < 150 mm Hg and
DBP