FRIDAY, Dec. 20, 2013 (HealthDay News) -- Evidence-based guidelines for the management of hypertension in adults for 2014 have been issued by the Eighth Joint National Committee, according to a special communication published online Dec. 18 in the Journal of the American Medical Association.
Paul A. James, M.D., from the University of Iowa in Iowa City, and colleagues reviewed the evidence to recommend treatment thresholds, goals, and medications for the management of hypertension in adults.
The authors note that strong evidence exists to support treating older patients (60 years or older) with hypertension to a blood pressure (BP) goal of 150/90 mm Hg, and younger patients (age 30 to 59 years) to a diastolic goal of less than 90 mm Hg. In the absence of sufficient evidence to fix a systolic BP goal in younger patients, or a diastolic goal for patients younger than 30 years, experts recommend a BP of less than 140/90 mm Hg. The same thresholds as for patients younger than 60 years are recommended for adults with hypertension and diabetes or non-diabetic chronic kidney disease (CKD). In the non-black population with hypertension, including those with diabetes, moderate evidence supports initiation of drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic. For black patients, initial recommended therapy is a calcium channel blocker or thiazide-type diuretic. For patients with CKD, moderate evidence supports use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.
"These recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient," the authors write.
Several authors disclosed financial ties to the pharmaceutical, medical device, and medical technology industries.
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