What Are the Thresholds for Initiating Treatment for High Blood Pressure as Listed in the Current JNC8 Guidelines?
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The recent joint guidelines of ASH/ISH, although utilizing the same major sources of evidence as the JNC 8 and European publications, also considered a wider range of research articles that could support a more complete and practical guidance for practitioners in the community.
Guidelines are required to be evidence based and identify best practises through impartial evaluation of the available data. The resulting guidelines should be simple to follow and straightforward to implement. They must provide flexible recommendations, which consider the country’s unique healthcare system, to both enable their implementation across a wide range of clinical practices and to facilitate patient specific personalisation of treatment.
A., Oparil S., Carter B. L., 2014). This is particularly true in the elderly (age, >60 yr), in whom issues such as cardiovascular risk, frailty, side effects, cost, and patient preference affect therapy more acutely.
Referral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies. Adults with CKD and hypertension should receive an ACE inhibitor or ARB as initial or add-on therapy, based on moderate evidence that these medications improve kidney-related outcomes in these patients.
Hasan R. S., Beiser A., Seshadri S., Larson M. G., Kannel W. B., D'Agostino R. B., Levy D. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287(8):1003–10.
Ezzati M., Vander Hoorn S., Lopez A. D., Danaei G., Rodgers A., Mathers C. D., Murray C. J. L. Comparative quantification of mortality and burden of disease attributable to selected risk factors. In: Lopez A. D., Mathers C. D., Ezzati M., Jamison D. T., Murray C. J. L., editors. Global burden of disease and risk factors. New York: Oxford University Press; 2006. pp. 241–396. p.
Heidenreich P. A., Trogdon J. G., Khavjou O. A., Butler J., Dracup K., Ezekowitz M. D. et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.
James P. A., Oparil S., Carter B. L., Cushman W. C., Dennison-Himmelfarb C., Handler J. et al. 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)