The following table illustrates the JNC 8 recommendations for the initial management of essential hypertension based on the patient’s characteristics and comorbid indications.
|JNC 8 Recommendation||Population||Goal BP (mmHg)||Strength of Recommendation|
|1||Age ≥60 years||<150/90||A (strong)|
|2||Age <60 years||DBP<90||A (strong) for ages 30-59E (expert opinion) for ages 18-29|
|3||Age <60 years||SBP <140||E|
|4||Chronic kidney disease ≥18 years||<140/90||E|
|5||Diabetes age ≥18||<140/90||E|
|These target blood pressures are generally higher than what has been routinely practiced by many providers prior to 2014. An important corollary to Recommendation 1 is that for patients >60 years old who are tolerating a blood pressure therapy that has resulted in a pressure below 140/90, it is acceptable to continue that treatment (based on expert opinion).|
Classification of Evidence Behind JNC 8 Guidelines
Of the above JNC 8 recommendations, note only two are “strong recommendations” (level A), based on quality of the evidence and degree of benefit: SBP and DBP target for the elderly, and a DBP target for ages 30-60. ForJNC 8, quality of evidence was judged high, moderate, or low based on study characteristics. There is often controversy around any guideline based on ‘expert opinion’ without rigorous RCT data, and some parts of the JNC 8 are no exception. It is also worth noting that there are no level D recommendations (against a particular practice) in JNC 8.
JNC 8 Evidence Quality Rating and Strength of Recommendations
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