AIPGMEE Hot topic JNC 8 Hypertension versus JNC 7 Hypertension


AIPGMEE Hot topic JNC8 vs JNC 7 guidelines

Already Bihar PGMAT 2014 , this MCQ appeared , hence prepare well and go

  • Important changes from the JNC 7 guidelines  given in JNC 8  guidelines include the following:

o   In patients 60 years of age or older who do not have diabetes or chronic kidney disease, the goal blood pressure level is now <150/90 mmHg (MCQ)

o   In patients 18 to 59 years of age without major comorbidities, and in patients 60 years of age or older who have diabetes, chronic kidney disease, or both conditions, the new goal blood pressure level is <140/90 mmHg (MCQ)

o   First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACEIs, and ARBs (MCQ)

o   Second- and third-line alternatives included higher doses or combinations of ACEIs, ARBs, thiazide-type diuretics, and CCBs

o   Several medications are now designated as later-line alternatives, including the following:

  • Beta-blockers
  • Alpha-blockers
  • Alpha1/beta-blockers (eg, carvedilol)
  • Vasodilating beta-blockers (eg, nebivolol)
  • Central alpha2-adrenergic agonists (eg, clonidine)
  • Direct vasodilators (eg, hydralazine)
  • Loop diuretics (eg, furosemide)
  • Aldosterone antagonists (eg, spironolactone)
  • Peripherally acting adrenergic antagonists (eg, reserpine)

o   When initiating therapy, patients of African descent without chronic kidney disease should use CCBs and thiazides instead of ACEIs

o   Use of ACEIs and ARBs is recommended in all patients with chronic kidney disease regardless of ethnic background, either as first-line therapy or in addition to first-line therapy

o   ACEIs and ARBs should not be used in the same patient simultaneously (Definite MCQ)

o   CCBs and thiazide-type diuretics should be used instead of ACEIs and ARBs in patients over the age of 75 with impaired kidney function due to the risk of hyperkalemia, increased creatinine, and further renal impairment

So what is the MCQ asked in Bihar PGMAT 2014

In the JNC 8 guidelines, the goal BP for elderly is

A. <150/90

B. <140/90

C. <160/90

D. <120/80

Answer A

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A Review of the JNC 8 Guidelines

Hypertension Today: JNC-8 Evidence-Based Guidelines

It has been over 8 years since the last and 7th Joint National Committee (JNC) report on Hypertension was published. Many issues on the Detection, Evaluation and Treatment of Hypertension have since occurred challenging the way clinicians should be treating patients with hypertension. The purpose of this lecture is to anticipate/predict how JNC8 should address these issues using an evidence-based review of the literature to support its recommendations. The content will include the importance of effective BP reduction, and the evidence for current and what future goals for BP reduction should be; the challenges of in-office BP detection and new information on the importance of out-of-office BP measurement; the controversies on the initial BP agent chosen for therapy and the differences within the thiazide-diuretic class; and the importance of dual-agent therapy and which combination agents are ideal for BP reduction

Webinar by DR. V. T. SHAH On “JNC 8 Guidelines-An Overview”

What’s New in Adult Hypertension: JNC 8