{"id":4999,"date":"2018-10-17T19:52:38","date_gmt":"2018-10-17T19:52:38","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1333"},"modified":"2026-02-11T19:36:16","modified_gmt":"2026-02-11T19:36:16","slug":"recommendations-for-management-of-hypertension-jnc-8","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/recommendations-for-management-of-hypertension-jnc-8\/","title":{"rendered":"Recommendations for Management of Hypertension (JNC 8)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>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.<!--more--><\/p>\n<p><strong>Recommendations for Management of Hypertension<\/strong><\/p>\n<p><strong>Recommendation 1<\/strong><br \/>\nIn the general population aged \u226560 years, initiate pharmacologic treatment\u00a0to lower blood pressure (BP) at systolic blood pressure (SBP) \u2265150\u00a0mm Hg or diastolic blood pressure (DBP) \u226590 mm Hg and treat to a goal\u00a0SBP &lt;150 mm Hg and goal DBP &lt;90 mm Hg.<\/p>\n<p><strong>Recommendation 2<\/strong><br \/>\nIn the general population &lt;60 years, initiate pharmacologic treatment to\u00a0lower BP at DBP \u226590 mm Hg and treat to a goal DBP &lt;90 mm Hg.<\/p>\n<p><strong>Recommendation 3<\/strong><br \/>\nIn the general population &lt;60 years, initiate pharmacologic treatment to\u00a0lower BP at SBP \u2265140 mm Hg and treat to a goal SBP &lt;140 mm Hg.<\/p>\n<p><strong>Recommendation 4<\/strong><br \/>\nIn the population aged \u226518 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP \u2265140 mm Hg or DBP \u226590\u00a0mm Hg and treat to goal SBP &lt;140 mm Hg and goal DBP &lt;90 mm Hg.<\/p>\n<p><strong>Recommendation 5<\/strong><br \/>\nIn the population aged \u226518 years with diabetes, initiate pharmacologic treatment to lower BP at SBP \u2265140 mm Hg or DBP \u226590 mm Hg and treat to goal SBP &lt;140 mm Hg and goal DBP &lt;90 mm Hg.<\/p>\n<p><strong>Recommendation 6<\/strong><br \/>\nIn the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB).<\/p>\n<p><strong>Recommendation 7<\/strong><br \/>\nIn the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB.<\/p>\n<p><strong>Recommendation 8<\/strong><br \/>\nIn the population aged \u226518 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status.<\/p>\n<p><strong>Recommendation 9<\/strong><br \/>\nThe main objective of hypertension treatment is to attain and maintain goal\u00a0BP. If goal BP is not reached within a month of treatment, increase the dose\u00a0of the initial drug or add a second drug from one of the classes in recommendation 6\u00a0(thiazide-type diuretic, CCB,ACEI, or ARB). The clinician should\u00a0continue to assess BP and adjust the treatment regimen until goal BP is\u00a0reached. If goal BP cannot be reached with 2 drugs, add and titrate a third\u00a0drug from the list provided. Do not use an ACEI and an ARB together in the\u00a0same patient. If goal BP cannot be reached using only the drugs in recommendation\u00a06 because of a contraindication or the need to use more than 3\u00a0drugs to reach goal BP, antihypertensive drugs from other classes can be\u00a0used. Referral to a hypertension specialist may be indicated for patients in\u00a0whom goal BP cannot be attained using the above strategy or for the management\u00a0of complicated patients for whom additional clinical consultation\u00a0is needed.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>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.\u00a02014 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).\u00a0JAMA. 2014 Feb 5;311(5):507-20. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24352797\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Murthy VL, Shah RV, Rubenfire M, Brook RD.\u00a0Comparison of the Treatment Implications of American Society of Hypertension and International Society of Hypertension 2013 and Eighth Joint National Committee Guidelines: an analysis of National Health and Nutrition Examination Survey.\u00a0Hypertension. 2014 Aug;64(2):275-80. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24821946\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Oct 12, 2018.<br \/>\nUp-date Feb 11, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[26],"tags":[384,385,379,67,66,383,378,380,259,260,381,200,382],"class_list":["post-4999","post","type-post","status-publish","format-standard","hentry","category-cardiology","tag-arterial","tag-committee","tag-eighth","tag-hipertension","tag-hypertension","tag-jnc","tag-jnc-8","tag-joint","tag-management","tag-manejo","tag-national","tag-recomendaciones","tag-recommendations"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/4999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=4999"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/4999\/revisions"}],"predecessor-version":[{"id":10660,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/4999\/revisions\/10660"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=4999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=4999"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=4999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}