title: 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).
abstract: Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
authors.affiliation: University of Iowa, Iowa City.
authors.forename: Paul A
authors.initials: PA
authors.lastname: James
authors.affiliation: University of Alabama at Birmingham School of Medicine.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: University of Iowa, Iowa City.
authors.forename: Barry L
authors.initials: BL
authors.lastname: Carter
authors.affiliation: Memphis Veterans Affairs Medical Center and the University of Tennessee, Memphis.
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dennison-Himmelfarb
authors.affiliation: Kaiser Permanente, Anaheim, California.
authors.forename: Joel
authors.initials: J
authors.lastname: Handler
authors.affiliation: Medical University of South Carolina, Charleston.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.affiliation: University of Missouri, Columbia.
authors.forename: Michael L
authors.initials: ML
authors.lastname: LeFevre
authors.affiliation: Denver Health and Hospital Authority and the University of Colorado School of Medicine, Denver.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: MacKenzie
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Ogedegbe
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Svetkey
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Taler
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Narva
authors.affiliation: at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers