Hypertension Treatment Guideline - Joint National Committee Recommendations

Guidelines for the Management of Hypertension | High Blood Pressure | Hypertension Symptoms | Hypertension Classification | Hypertension Complications | Hypertension Causes | Hypertension Treatment | Hypertension Treatment Medicines  

Introduction

High blood pressure (Hypertension) is when the pressure in blood vessels is too high (140/90 mmHg or higher). Hypertension is also known as high or raised blood pressure. It is common condition but can be serious if not treated. Hypertension is a potent risk factor the development of heart, brain, kidney and other diseases. 

Symptoms of Hypertension

People with hypertension can experience some symptoms including:
·        Headaches
·        Chest pain
·        Dizziness
·        Nosebleeds
·        Irregular heart rhythms
·        Vision changes
·        Buzzing in the ears
·        Fatigue
·        Nausea
·        Vomiting
·        Confusion
·        Anxiety
·        Muscle tremors and
·        Difficulty breathing

Hypertension Causes or Hypertension Risk Factors

Factors that increase the risk of high blood pressure are:
·        Older age
·        Genetics
·        High body weight or overweight
·        Physically inactivity most of the time   
·      Unhealthy diets (high-salt intake, saturated fat and trans fats in diet, low intake of fruits and vegetables)
·        Drinking too much alcohol
·    Co-existing medical problems such as diabetes or kidney disease.

Blood Pressure Categories According to American College of Cardiology (ACC) and American Heart Association (AHA) Hypertension Guidelines

1)    Normal -  <120 systolic and <80 mm Hg diastolic 

2)    Elevated - 120–129 systolic and <80 mm Hg diastolic 

3)    Stage 1 hypertension - 130–139 systolic or 80–89 mm Hg diastolic 

4)    Stage 2 hypertension - ≥140 systolic or ≥90 mm Hg diastolic

BP readings should not be based on at a single point in time but rather should be confirmed by two or more readings (averaged) made on at least two separate occasions.

Key facts about Hypertension

• Hypertension is a major cause of premature death worldwide

• An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension

• 46% of adults with hypertension are unaware that they have the condition

Recommended Lifestyle Changes in Hypertension

Lifestyle changes: ·   Smoking Cessation ·   Control blood glucose and lipids ·   Diet: Eat healthy [i.e., Dietary Approaches to Stop Hypertension (DASH) diet] Diet rich in fruits, vegetables, whole grains and low-fat dairy products with reduced saturated and total fat Moderate alcohol consumption Reduce sodium intake to no more than 2,400 mg/day Increased intake of dietary potassium 3500–5000 mg/d ·   Physical activity Moderate-to-vigorous activity 3-4 days a week averaging 40 min per session ·   Weight loss if overweight/obese

Initial Drugs of Choice for Hypertension: ·    ACE inhibitor (ACEI) ·    Angiotensin receptor blocker (ARB) ·    Thiazide diuretic ·    Calcium channel blocker (CCB)

Initiate Treatment in Population and Age Group as per below Blood Pressure Value

Population	Age group	Blood group
General population	Adults 60 years and older	150/90 mm Hg or higher
	Adults younger than 60 years	140/90 mm Hg or higher
Patients with hypertension and diabetes	Regardless of age	140/90 mm Hg or higher
Chronic kidney disease (CKD) or diabetes mellitus (DM)	18 years or older	140/90 mm Hg or higher

Initial antihypertensive treatment should include:

•    Thiazide diuretic
•    Calcium channel blocker
•    ACE inhibitor, or ARB in the general nonblack population
•    Thiazide diuretic or calcium channel blocker in the general black population

Nonblack population (Including those with diabetes)

Initial antihypertensive treatment should include:

• Thiazide diuretic

• Calcium channel blocker

• Angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB)

Black population (Including those with diabetes)

Initial treatment should include:

• Thiazide diuretic or calcium channel blocker.

 

Treatment Recommendation in Compelling Indications

Compelling Indications
Indication	Treatment Choice
Heart Failure	ACEI/ARB + BB + diuretic + spironolactone
Post –MI/Clinical CAD	ACEI/ARB AND BB
CAD	ACEI, BB, diuretic, CCB
Diabetes	ACEI/ARB, CCB, diuretic
CKD	ACEI/ARB
Recurrent stroke prevention	ACEI, diuretic
Pregnancy	Labetolol (first line), nifedipine, methyldopa

ACEI - Angiotensin-converting enzyme inhibitors
ARB - Angiotensin II receptor blockers
BB - Beta blockers
CCB - Calcium channel blocker
CKD - Chronic kidney disease
CAD - Coronary artery disease
MI - Myocardial infarction

Read more: Diabetes !! Diabetes mellitus !! Type 1 Diabetes !! Type 2 Diabetes !! Diabetes Symptoms !! Treatment for diabetes

Note: Information in this article is from latest guideline but for educational purpose only. Kindly take qualified healthcare professional advice before taking any medicine. 

Reference:

1. Hypertension Key facts. Accessed from https://www.who.int/news-room/fact-sheets/detail/hypertension.

2. Hypertension: Eighth Joint National Committee (JNC 8) Recommendations. Accessed from https://www.justintimemedicine.com/curriculum/201.

3. JNC 8 Guidelines for the Management of Hypertension in Adults. Accessed from https://www.aafp.org/dam/brand/aafp/pubs/afp/issues/2014/1001/p503.pdf.

4. Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020 Apr;30(3):160-164.