The Eighth Joint National Committee (JNC 8) released new guidelines for managing high blood pressure at the beginning of the year:
The guidelines included 9 evidence-based recommendations and a flow chart to assist physicians in their treatment of patients. I’ve excerpted the levels to initiate treatment below and highlighted the treatment cut-off for people with diabetes (140/90):
Recommendation 1: In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg.
Recommendation 2: In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP ≥90 mm Hg.
Recommendation 3: In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg.
Recommendation 4: In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg.
Recommendation 5: In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg.
Recommendation 9: The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient.
The panel also said:
“For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”