|Published (Last):||13 August 2008|
|PDF File Size:||10.49 Mb|
|ePub File Size:||2.33 Mb|
|Price:||Free* [*Free Regsitration Required]|
Because the panel conducted its own systematic review using original studies, systematic reviews and meta-analyses of RCTs conducted and published by other groups were not included in the formal evidence review.
The JNC 8 Hypertension Guidelines: An In-Depth Guide
While physicians use cost, adherence, and often observational data to make treatment decisions, medical interventions should whenever possible be based first and foremost on good science demonstrating benefits to patients. Recommendation 9 is based on strategies used in RCTs that demonstrated improved patient outcomes and the blold and clinical experience of panel members.
The effects of jnc 8 blood pressure guidelines pdf download protein restriction and blood-pressure control on the progression of chronic renal disease.
Hypertension remains one of the most important preventable contributors to disease and death. Refocusing the agenda on cardiovascular guidelines: For approved evidence statements, the panel then voted on the quality of the evidence Table 2. However, this lower SBP goal is not supported by any RCT that randomized participants into 2 or more groups in which treatment was initiated at a lower SBP threshold than mm Hg or into treatment groups in which the SBP goal was lower than mm Hg and that assessed the effects of a lower SBP threshold or goal on important health outcomes.
Recommendation 8 applies to adults aged 18 years or older with CKD, but there is no evidence to support renin-angiotensin system inhibitor treatment in those older than 75 years. However, these recommendations are not a jnc 8 blood pressure guidelines pdf download for clinical judgment, and decisions about care jnc 8 blood pressure guidelines pdf download carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
Guideline for Management of High Blood Pressure | Cardiology | JAMA | The JAMA Network
Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. Standards for Systematic Reviews. Strategies to Dose Guidelihes Drugs a. While all panel members agreed that the evidence jnc 8 blood pressure guidelines pdf download recommendation 1 is very strong, the panel was unable to reach unanimity on the recommendation of a goal SBP of lower than mm Hg.
Therefore, these drug classes are not recommended as first-line therapy.
Report by the Management Committee. Therefore, each strategy is an acceptable pharmacologic treatment strategy that can be tailored based on individual circumstances, clinician and patient preferences, and drug tolerability. First, many people will require treatment with more than one antihypertensive drug to achieve BP control. Recommendation 9 was developed by the panel in response to a perceived need for further guidance to assist in implementation of recommendations 1 through 8.
The evidence review focused on adults aged 18 years or older with hypertension and included studies with the following prespecified subgroups: There is moderate-quality evidence from jnc 8 blood pressure guidelines pdf download trials SHEP, Syst-Eur, and UKPDS that treatment to an SBP goal of lower than mm Hg improves cardiovascular and cerebrovascular health outcomes and lowers mortality see question 2, evidence statement 18 in adults with diabetes jnc 8 blood pressure guidelines pdf download hypertension.
The 2014 JNC 8 and 2017 AHA/ACA Guidelines for Management of High Blood Pressure in Adults
There is not likely to be evidence blkod well-designed RCTs jnc 8 blood pressure guidelines pdf download compare these strategies and assess their effects on important health outcomes. There is also evidence albeit low quality from evidence statement 6, question 2 that setting a goal SBP of lower than mm Hg in this age group provides no additional benefit compared with a higher goal SBP of to mm Hg or to mm Hg.
Based on the evidence reviewed for questions 1 through 3 and on the expert opinion of the panel members, it is not known if one of the strategies results in improved cardiovascular outcomes, cerebrovascular outcomes, kidney outcomes, or downooad compared with an alternative strategy. This Viewpoint proposes blood pressure treatment thresholds given important trials published after JNC8.
However, this algorithm has not been validated with respect jnc 8 blood pressure guidelines pdf download achieving improved patient outcomes. Quiz Ref ID For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. What Do I Need to Know? Use of an ACEI or an ARB will commonly increase serum creatinine and may produce other metabolic effects such as hyperkalemia, particularly in patients with decreased kidney function.
In contrast to the JNC 7 guideline recommendation, the guideline is driven by a systematic review of clinical trial evidence.
Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease REIN Although adverse effects and harms of antihypertensive treatment documented in the RCTs were considered when the panel made its decisions, the review was not designed to determine whether therapy-associated adverse effects and harms resulted in significant changes in important health outcomes.
The panel elected to pursue publication independently to bring the recommendations to the public in a jnc 8 blood pressure guidelines pdf download manner while maintaining the integrity of the predefined process. Blood-pressure targets in patients with recent lacunar stroke: Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more.
Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: