Clinical Practice Guideline

Hypertension

Management of High Blood Pressure in Adults

(Endorsed, July 2014)

The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults, was developed by panel members appointed to the Eighth Joint National Committee (JNC 8) and was endorsed by the American Academy of Family Physicians.

Key Recommendations

  • In the general population aged ≥ 60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥ 150 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg to a goal SBP < 150 mmHg and goal DBP < 90 mmHg.
  • In the general population < 60 years, initiate pharmacologic treatment to lower BP at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg to a goal SBP < 140 mmHg and goal DBP < 90 mmHg.
  • In the population aged ≥ 18 and < 70 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg and treat to goal SBP < 140 mmHg and goal DBP < 90 mmHg. Initial (or add-on) antihypertensive treatment should include an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) to improve kidney outcomes, regardless of race.
  • In the population aged ≥ 18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg and treat to a goal SBP < 140 mmHg and goal DBP < 90 mmHg.
  • In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), ACEI, or ARB.
  • In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB.
  • The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the recommended classes (thiazide-type diuretic, CCB, ACEI, or ARB). Continue to assess BP and adjust the treatment regimen until goal BP is reached, adding a third drug if needed. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using the recommended drug classes because of a contraindication or the need to use more than 3 drugs to reach goal, antihypertensive drugs from other classes can be used.
  • Consider referral to a hypertension specialist for patients in whom goal BP cannot be attained or for complicated patients.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.