The Eighth Report of the Joint National Committee (JNC 8) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

The JNC 8 hypertension guidelines use a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults1. Evidence was drawn from randomised controlled trials, which represent the gold standard for determining efficacy and effectiveness1. This is an independent publication developed under the Chairmanship of Paul A. James, M.D. (University of Iowa, Iowa City, IA)1.

Recommendations for the use of CCBs

In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, CCB, ACE inhibitor, or angiotensin receptor blocker.
In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB.
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 following classes: thiazide-type diuretic, CCB, ACEI, or ARB.

Additional observations

The panel noted a potential conflict between the recommendation to use an ACEI or ARB in those with CKD and hypertension and the recommendation to use a diuretic or CCB in black persons. In black patients with CKD and proteinuria, an ACEI or ARB is recommended as initial therapy because of the higher likelihood of progression to ESRD. In black patients with CKD but without proteinuria, the choice for initial therapy includes a thiazide-type diuretic, CCB, ACEI, or ARB.

JNC 8 algorithm for treatment of hypertension

SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ACEI, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; and CCB, calcium channel blocker.

a ACEIs and ARBs should not be used in combination.

B If blood pressure fails to be maintained at goal, reenter the algorithm where appropriate based on the current individual therapeutic plan.

References

  1. James PA, et al. JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.