The proportion of U.S. adults recommended for hypertension treatment would decrease and the proportion with treatment-eligible hypertension meeting blood pressure (BP) goals would increase under the latest BP guideline, according to a recent study published online ahead of print in the Journal of the American Medical Association.

The “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults” issued by the Eighth Joint National Committee (JNC 8) recommends an increase in systolic BP treatment goal to 150/90 mm Hg from 140/90 mm Hg in the general population and to 140/90 mm Hg from 130/80 mm Hg in patients with chronic kidney disease (CKD) and diabetes.

Ann Marie Navar-Boggan, MD, PhD, of the Division of Cardiology at Duke University Medical Center in Durham, N.C., and colleagues collected 2005-2010 data from NHANES to study the proportion of adults who would be affected by the recommendations. They identified 16,372 patients with BP measurements.

Continue Reading

The researchers found that the 2014 BP guidelines were associated with a decrease in overall rates of treatment-eligible hypertension (29.0%) compared with the previous JNC 7 guidelines (31.7%).

Extrapolating from their findings, the researchers estimated that the number of U.S. adults no longer classified as needing hypertension medication would decrease by 5.8 million adults under JNC 8 versus JNC 7. They noted that the 2014 guidelines are unclear as to whether these patients should still be considered hypertensive.

Additionally, among patients with treatment-eligible hypertension, 56.5% would achieve goal BP under the new guidelines compared with 40.6% with JNC 7. This change would be more pronounced among older adults, with 65.8% meeting BP goals under the 2014 guidelines versus 40.0% under JNC 7.

Expert Commentary

JNC8 guidelines do relax the blood pressure cut offs. However, this could mean less side-effects from over therapy especially in older patients. It also relaxes the goal BP in patients with DM2 or CKD from 130/80 to 140/90 mm Hg.

The JNC8 guidelines adhere closely to the Institute of Medicine (IOM) standards for establishing guidelines. Because of this, JNC8 is a completely different document from JNC7.

It is a narrower document that doesn’t attempt to be a comprehensive guide to hypertension management.

eAJKD, the official blog of the American Journal of Kidney Diseases