Updated Guidelines for Management of High Blood Pressure

Hypertension is a common major risk factor for cardiovascular disease and stroke.It is estimated that in 2010, nearly 78 million US adults (aged ≥20 years) had high blood pressure, but in approximately 50%, hypertension was not adequately controlled. 1 Most patients with hypertension are treated by primary care physicians; treatment is effective and includes both lifestyle interventions and relatively inexpensive medications.The importance of detecting and treating hypertension is well-recognized by professional societies and federal agencies.In their article published in JAMA, the panel members appointed to the Eighth Joint National Committee (JNC 8) report their Evidence-Based Guideline for the Management of High Blood Pressure in Adults. 2 This guideline has been long-awaited and much anticipated, with the last revision of the blood pressure guidelines, the JNC 7 report, having been published in JAMA in 2003. 3An update of this decade-old guideline is overdue, considering that about half of the major recommendations in guidelines become outdated in approximately 6 years. 4s the panel members describe in the report, 2 the JNC 8 committee was appointed in 2008 by the National Heart, Lung, and Blood Institute (NHLBI) and was charged with reviewing and synthesizing the most recent available scientific evidence, updating existing clinical recommendations, and providing guidance for clinicians on the best approaches to manage and control high blood pressure to minimize the risk of cardiovascular events and other complications.The panel used rigorous evidence-based methods and developed evidence statements and recommendations for blood pressure treatment based on a systematic review of available randomized controlled trials.The panel focused on 3 critical questions that address thresholds and goals for pharmacologic treatment of hypertension: (1) in adults with hypertension, does initiating antihypertensive pharmacologic therapy at specific blood pressure thresholds improve health outcomes?(2) in adults with hypertension, does treatment with antihypertensive pharmacologic therapy to a specified blood pressure goal lead to improvements in health outcomes?and (3) in adults with hypertension, do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes?In addition to the 9 recommendations and the treatment algorithm based on their systematic review of the evidence and included in their article, 2 the authors also provide the comprehensive evidence review and methods in an online supplement.Importantly, despite the care in formulating their evidence-based guideline, the panel members clearly acknowledge that their recommendations are not a substi-