JNC 7 made specific recommendations for blood pressure treatment for a wide range of other specific comorbid, compelling indications (see below).With the exception of diabetes and renal disease mentioned earlier, JNC 8 did not comment on any of these other conditions specifically and they were not part of the review. “Clinicians often provide care for patients with numerous comorbidities or other important issues related to hypertension, but the decision was made to focus on…questions considered to be relevant to most physicians and patients.” (JNC 8, 2013).
Despite not being part of the JNC 8 recommendations, most providers may continue to choose antihypertensive therapy carefully for these other specific compelling indications, either as initial or add-on therapy, as listed below:
| Compelling Indications for Individual Drug Classes | ||
|---|---|---|
| Compelling Indication | Initial Therapy Options |
Clinical Trial Basis
|
|
Heart failure
|
THIAZ, BB, ACEI, ARB, ALDO ANT
|
ACC/AHA Heart Failure Guideline, MERIT-HF, COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES
|
|
Postmyocardial infarction
|
BB, ACEI, ALDO ANT
|
ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS
|
|
High CAD risk
|
THIAZ, ACE, CCB
|
ALLHAT, HOPE, ANBP2, LIFE, CONVINCE
|
| Recurrent stroke prevention/stroke prevention | THIAZ, ACEI | PROGRESS |
CHF
Diuretics reduce heart failure; beta blockers reduce cardiac work demand; and ACE inhibitors and ARBs reduce afterload. Low dose aldosterone antagonists reduce morbidity and mortality in CHF but these agents should not be titrated to higher levels (as other BP medications) as they may be associated with negative outcomes.
| << Drug Therapy for Adults With Compelling Indications |