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2014 Evidence-Based Guidelines

for the Management of High


Blood Pressure in Adults
Compiled by : Chandra Permana

Lecturer : dr. Suryono, Sp. JP


FIHA
This hypertension guideline focuses on 3 questions related to high blood pressure
(BP) management. They address thresholds, goals for pharmacologic treatment,
and whether particular antihypertensive drugs or drug classes improve important
health outcomes compared to others.
1. In adults with hypertension, does initiating antihypertensive pharmacologic therapy
at specific BP thresholds improve health outcomes?
2. In adults with hypertension, does treatment with antihypertensive pharmacologic
therapy to a specified BP goal lead to improvements in health outcomes?
3. In adults with hypertension, do various antihypertensive drugs or drug classes
differ in comparative benefits and harms on specific health outcomes?

 The answers to these three questions are reflected in 9 recommendations


 Recommendation 1 BP thresholds Goals
(Strong recommendation)
General population SBP ≥150 mm Hg SBP <150 mm Hg
≥60 years or DBP ≥90 mm Hg and DBP <90 mm Hg

 Recommendation 2
(Strong recommendation)
General population
DBP ≥90 mm Hg DBP <90 mm Hg
<60 years
 Recommendation 3 BP thresholds Goals
(Expert opinion)

General population
SBP ≥140 mm Hg SBP <140 mm Hg
<60 years

 Recommendation 4
(Expert opinion)

Population with CKD SBP ≥140 mm Hg SBP <140 mm Hg


≥18 years or DBP ≥90 mm Hg and DBP <90 mm Hg
CKD: chronic kidney disease
 Recommendation 5 BP thresholds Goals
(Expert opinion)

Population with diabetes SBP ≥140 mm Hg SBP <140 mm Hg


≥18 years or DBP ≥90 mm Hg and DBP <90 mm Hg

Initial treatment
 Recommendation 6
(Moderate recommendation)
Thiazide-type diuretic,
General nonblack calcium channel blocker (CCB),
population (with diabetes) angiotensin-converting enzyme inhibitor (ACEI),
or angiotensin receptor blocker (ARB)
 Recommendation 7
(Moderate recommendation)
Initial treatments

General (with diabetes) Thiazide-type diuretic,


black population or calcium channel blocker (CCB)

 Recommendation 8
Initial or add-on treatments
(Moderate recommendation)

Population with CKD ≥18 Angiotensin-converting enzyme inhibitor (ACEI),


years or angiotensin receptor blocker (ARB)
 Recommendation 9 Non control strategies
(Expert opinion)

Goal BP not reached Increase the dose of the initial drug,


within a month of treatment or add a second drug (from the list provided)

Goal BP not reached Add and titrate a third drug (from the list provided)
with 2 drugs Do not use an ACEI and an ARB together in the same patient
• This JNC8 guideline has not redefined high BP, and considers the
140/90 mm Hg definition from JNC 7 reasonable.
• It offers clinicians an analysis of what is known and not known
about BP treatment thresholds, goals, and drug treatment
strategies to achieve those goals.
• However 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.