正2014年美国预防、检测、 评估与治疗高血压全国联合委员会(JNC)第8次报告成人高血压治疗指南(简称JNC8指南)重点回答了以下3个方面的问题：1启动降压治疗界值;2降压 靶目标值;3采用何种降压药物进行起始治疗。针对这3个问题给予9项推荐。1何时启动成人高血压患者的药物治疗JNC8指南推荐：对于≥60岁的高血压患 者，收缩压≥150mm Hg和(或)舒张压≥90mm Hg即可启动药
Wednesday, May 16, 10:00 AM to 12:00 PM New Directions in Hypertension Management - Beyond JNC VI*: An analysis of recent clinical trials and their impact on JNC VI guidelines*
Hypertension treatment prior to 1996 and 1997 demonstrated a dramatic decrease in both cerebrovascular and cardiovascular events with diuretic and beta blocker therapy. On the basis of this experience， the JNC VI recommended that these agents be used as initial therapy unless there were specific indications for other medications. Since that time several trials have been published comparing older medications， specifically diuretics and beta blockers with newer medications， i.e.， ACE inhibitors and calcium channel blockers (CCBs). In addition， trials comparing CCB treated patients with ACE inhibitor treated patients have also been published. Results indicate that the use of a beta blocker/diuretic-based treatment program will reduce morbidity/mortality to the same degree as ACE inhibitor/ CCB-based programs both in diabetics， non diabetics and in the elderly. Studies with CCBs also indicate that these agents may be less effective in reducing myocardial infarction and heart failure than diuretics or ACE inhibitors but may be more effective in reducing strokes. The recommendations of the JNC for the use of diuretics or beta blockers as initial therapy except in special situations is still reasonable. Based on results of the UKPDS， the Japanese， the STOP-2 in the Elderly， and the NORDIL and INSIGHT studies， certain changes may be indicated in these recommendations. Evidence suggests that an ACE inhibitor with or without a diuretic should be added to the list as initial treatment along with diuretics and beta blockers. While CCBs are effective and generally well tolerated， it would appear that the beneficial effects of these agents on CHD events is less than when ACE inhibitors or diuretics are used. The necessity to use multiple medications to reduce blood pressure to goal levels has been confirmed.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report—Correction
Incorrect Drug Trade Names： In the Special Communication entitled "The Seventh Report of the Joint National Committee on Prevention， Detection， Evaluation， and Treatment of High Blood Pressure： the JNC 7 Report" published in the May 21， 2003， issue of THE JOURNAL (2003;289：2560-2572)， there were incorrect drug trade names in Table 4 and Table 5 . On page 2566， in Table 4 ， the trade name "Tevetan" should have read "Teveten" and on page 2567， in Table 5 ， the trade name "Aldactone" should have read "Aldactazide." In addition， on page 2565， in column 1， the first full sentence should have read "When BP is more than 20 mm Hg above the systolic BP goal or 10 mm Hg above the diastolic BP goal， consideration should be given to initiating therapy with 2 drugs， either as separate prescriptions or in fixed-dose combinations (Figure)."
Investigating the Consistancy Rate of Hypertension Treatment through Guide Line JNC-7, in Patients Who Were Referred to Health Centers and Health Houses of Fasa University of Medical Sciences 2012
Background & Objective： Choosing antihypertensive as a drug for treating hypertension is the most important part of its treatment. The present study was done in investigating the consistancy rate of hypertension treatment through Guide Line JNC-7 in patients who were referred to health centers and health houses of Fasa University of Medical Sciences in 2012. Materials & Methods： In this cross-sectional study， the non-random sample of population was consisted of 200 patients who were suffering from hypertension. The questionnaire contained both demographic information and the use of anti-hypertension medication based on guide line (JNC-7). After the confirmation approval of content validity and reliability of the questionnaire， the data and the descriptive statistics were analyzed through SPSS-15 software. Results： 60 % of the patients were in the first stage of hypertension and 40 percent of them were in the second one. Beta blockers were the most common prescribed drugs which were used among the first stage patients. However， ACEI and Diuretics (Thiazides) were the commonly prescribed drugs for the second stage hypertension patients. Patients who had diabetes and heart failure were used Beta-blocker drugs which was not in line with the Guide line JNC-7. Conclusions： The treatment of hypertension in patients was not in consistence with guideline JNC-7. It is recommended to organize training classes for doctors to inform patients about the better way of treating this problem.
The new 2014 blood pressure (BP) guideline released by the panel members appointed to the Eighth Joint National Committee (JNC 8; 2014 BP guideline) proposed less restrictive BP targets for adults aged 60 years or older and for those with diabetes and chronic kidney disease.To estimate the proportion of US adults potentially affected by recent changes in recommendations for management of hypertension.Cross-sectional， nationally representative survey.Using data from the National Health and Nutrition Examination Survey between 2005 and 2010 (n = 16，372)， we evaluated hypertension control and treatment recommendations for US adults.Proportion of adults estimated to meet guideline-based BP targets under the 2014 BP guideline and under the previous seventh Joint National Committee on Prevention， Detection， Evaluation， and Treatment of High Blood Pressure (JNC 7) guideline.The proportion of younger adults (18-59 years) with treatment-eligible hypertension under the JNC 7 guideline was 20.3% (95% CI， 19.1%-21.4%) and decreased to 19.2% (95% CI， 18.1%-20.4%) under the 2014 BP guideline. Larger declines were observed among older adults (≥60 years)， decreasing from 68.9% (95% CI， 66.9%-70.8%) under JNC 7 to 61.2% (95% CI， 59.3%-63.0%) under the 2014 BP guideline. The proportion of adults with treatment-eligible hypertension who met BP goals increased slightly for younger adults， from 41.2% (95% CI， 38.1%-44.3%) under JNC 7 to 47.5% (95% CI， 44.4%-50.6%) under the 2014 BP guideline， and more substantially for older adults， from 40.0% (95% CI， 37.8%-42.3%) under JNC 7 to 65.8% (95% CI， 63.7%-67.9%) under the 2014 BP guideline. Overall， 1.6% (95% CI， 1.3%-1.9%) of US adults aged 18-59 years and 27.6% (95% CI， 25.9%-29.3%) of adults aged 60 years or older were receiving BP-lowering medication and meeting more stringent JNC 7 targets. These patients may be eligible for less stringent or no BP therapy with the 2014 BP guideline.Compared with the JNC 7 guideline， the 2014 BP guideline from the panel members appointed to the JNC 8 was associated with a reduction in the proportion of US adults recommended for hypertension treatment and a substantial increase in the proportion of adults considered to have achieved goal BP， primarily in older adults.
正第8届美国预防、检测、评估 和治疗高血压委员会(JNC 8)报告了基于证据的成年高血压管理指南(简称JNC 8)，于2013年12月18日由JAMA杂志在线发表~()。该指南简明扼要，操作性强，目的明确，提出了3个重要问题，3大策略和9条治疗推 荐。本文浅谈9条治疗推荐对我国血压管理的指导和借鉴作用。推荐1：目标人群：≥60岁，收缩压(SBP)≥150 mmHg(1 mmHg=0.133 kPa)或舒张压
最近国际上连续发表了一系列有关高血压管理指南，特别引人关注的是当地时间2013年12月17日美国高血压学会(ASH)/国际高血压学会(ISH)，在《临床高血压杂志》(J Clin Hypertension)在线发布了《社区高血压管理临床实践指南》(简称ASH/ISH指南).次日2013年12月18日《美国医学会杂志》(JAMA)在线发表了美国预防、检测、评估和治疗高血压委员会(JNC)8专家组成员发布的报告《2014成人高血压管理循证医学指南》2(简称JNC8指南).1周内由2个国际权威机构对同一问题发布了两部指南，在一定程度上反映了高血压领域面对在监测和治疗手段已经十分完善的今天，仍未能有效控制高血压这一尴尬局面的焦虑与分歧.高血压是在初级医疗中最常见的情况，并可导致心肌梗死、中风、肾衰，如果没有早期发现和进行适当的治疗易引起死亡.病人需要确保获得降压治疗以降低他们的疾病负担，同时临床医生也希望用最好的科学证据对高血压的管理加以指导.本研究采用严格的，以证据为基础的方法，推荐治疗阈值，目标和药物在成年人高血压管理中的应用.证据来自随机对照试验，它代表确定疗效和有效性的金标准.证据质量和推荐根据其疗效进行分级.
Assessment of Prescribing Pattern for Hypertension and Comparison with JNC-8 Guidelines-Proposed Intervention by Clinical Pharmacist
Background： Hypertension is a common disorder that if not effectively treated results in greatly increased probability of coronary thrombosis， strokes， and renal failures. It is estimated that the prevalence of hypertension in India is about 25% among urban adults and 10% in the rural areas. The lifetime risk of developing hypertension is estimated to be 90%. To assess prescribing pattern in hypertensive patients and assessing the rationality in regards to JNC-8 Guidelines in a tertiary care hospital. Methodology： It was a prospective， observational study conducted for 6 months with of 75 hypertensive prescriptions with diabetes mellitus and/ or chronic kidney disease who get admitted in the hospital were screened for the study. Result： In a total of 75 prescriptions， 14 (18.7%) prescriptions were found in the age group of less than 50 years， in which 10 (13.3%) were males and 4 (5.4%) were females and 36 (48%) prescriptions were comes under the age group between 51–65 years， in which 26 (34.7%) were males and 10 (13.3%) were females. Also 25 (33.3%) prescriptions were comes under the age group of above 65 years， in which 20 (26.7%) were males and 5 (6.7%) were females. Among mono therapy 22 (47.8%) prescriptions had diuretics as antihypertensive drug followed by CCB 11 (24%)， ARBs 7 (15.1%)， β blockers 3 (6.5%)， ACEIs 1 (2.2%)， α blockers 1 (2.2%) and α+β blockers 1 (2.2%). When compared with JNC 8 Guidelines it was observed that 28% of prescriptions were rational and 56% of prescriptions were irrational. Regarding the perception of physicians towards JNC 8 guidelines it was found that majority were not following JNC 8 guidelines.Key words： Hypertensive’s， Combination therapy， Co-morbidity， JNC 8 Guidelines.
[JNC 8 is released… but this is not the JNC 8! New US guidelines for the management of hypertension].
During year 2013， several recommendations for the management of hypertension were published： recommendations of the French and European Societies of Hypertension and two recommendations from the USA， those from the ACC/AHA/CDC groups and those from the JNC 8. The recommendations of the JNC 8 are not， strictly speaking， the recommendations of JNC 8， since they are neither endorsed by their sponsor： the National Heart， Lung and Blood Institute (NHLBI)， nor by any other supervisor. They only commit their authors. Just before the publication of the JNC 8， "competing" recommendations， jointly produced by the AHA， ACC and CDC， were jointly published in Hypertension and in the Journal of American College of Cardiology， with different preferred treatment choices and significantly different algorithms. The authors of the JNC 8 have only included in their literature review randomized controlled trials of sufficient power. Randomized controlled trials are clearly the gold standard of comparative trials in medicine， but can they summarize all the knowledge? The authors of the JNC 8 propose in subjects over 60， a therapeutic threshold and target blood pressure of 150/90mmHg. This original threshold is poorly supported by the evidence and possibly increases the risk of physicians' inertia. The issue of experts' conflicts of interest has greatly changed the rules of drafting guidelines for clinical practice. Knowing that the vast majority of clinical trials is promoted by drug industry， could guidelines be strictly without any conflict of interest? Finally， recommendations for practice should have as primary， if not unique， objective to improve the practice.
The Joint National Committee Report on the Prevention， Detection， Evaluation， and Treatment of High Blood Pressure (JNC) has been in existence for more than three decades with the first report published in 1977. The purpose of this report is to provide an authoritative review and summary of available data from clinical trials that will educate and update healthcare providers on approaches to treatment and cardiovascular risk reduction of appropriate patients. In addition， changes in guidance based on the JNC 8 document recently published are discussed. Please note that the JNC was initially intended to be updated every 4–5 years as data became available that would further solidify or change practice patterns. JNC 8 was published 10 years after JNC 7， so a departure from previous guidelines.