What are the JNC 8 recommendations for the management of high blood pressure in adults?
Recomendation 1: In the general population of 60 or older, initiate pharmacological treatment to reduce blood pressure with a systolic blood pressure (SBP) of 150 mm Hg or higher, or with a diastolic blood pressure (DBP) of 90 mm Hg or higher, and treat to a goal of SBP less than 150 mm Hg and a goal of DBP less than 90 mm Hg (strong recommendation - grade A).
Recomendation 2: In the general population younger than 60 years, initiate pharmacological anti-hypertensive treatment to reduce DBP that is greater than or equal to 90 mm Hg, and treat it to a goal of less than 90 mm Hg (for ages between 30 and 59 years it is a strong recommendation - grade A; for ages between 18 and 29 years it is an expert opinion - grade E).
Recomendation 3: In the general population younger than 60 years, initiate pharmacological anti-hypertensive treatment to reduce SBP that is greater than or equal to 140 mm Hg, and treat it to a goal of less than 140 mm Hg (expert opinion - grade E).
Recomendation 4: In the general population aged 18 or older with chronic kidney disease, initiate pharmacological anti-hypertensive treatment to reduce SBP that is greater than or equal to 140 mm Hg and DBP that is greater than or equal to 90 mm Hg, and treat it to a goal of less than 140 mm Hg and less than 90 mm Hg (expert opinion - grade E).
Recomendation 5: In the general population aged 18 or older with diabetes, initiate pharmacological anti-hypertensive treatment to reduce SBP that is greater than or equal to 140 mm Hg and DBP that is greater than or equal to 90 mm Hg, and treat it to a goal of less than 140 mm Hg and less than 90 mm Hg respectively (expert opinion - grade E).
Recomendation 6: If excluding blacks, in the general population, including diabetics, initial treatment should include a thiazide-type diuretic, a calcium channel blocker (CCB), an angiotensin-converting enzyme inhibitor (ACEI), or an angiotensin receptor blocker (ARB) (moderate recommendation - grade B).
Recomendation 7: In the general population of black patients, including those with diabetes, initial anti-hypertensive treatment should include a thiazide-type diuretic or a calcium channel blocker (moderate recommendation - grade B for the black population, and weak recommendation - grade C for black patients with diabetes).
Recomendation 8: In the population aged 18 or older with chronic kidney disease and hypertension, initial (or added) anti-hypertensive treatment should include an ACEI or an ARB to improve renal events. This applies to all patients with chronic kidney disease and hypertension, regardless of ethnicity or the presence of diabetes (moderate recommendation - grade B).
Recomendation 9: The main goal of treatment is to achieve and maintain the blood pressure goal. If this is not achieved within a month of treatment, increase the dose of the initial drug or add a second drug from the classes mentioned in recommendation 6. The physician should continue to adjust the treatment until the blood pressure goal is achieved. If this is still not achieved, add and titrate a third drug from the list. Do not use an ACEI and an ARB together in the same patient. Drugs from other classes may be used if the blood pressure goal cannot be achieved using the recommended drugs due to a contraindication or the need to use more than 3 drugs. Referral to a hypertension specialist may be indicated if the goal pressure cannot be achieved using the previous strategy or for the management of complicated patients (expert opinion - grade E).