Week 3 Discussion 1 Hypertension Q1. Please briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.

 

The publication of an evidence-based guideline for the prevention, detection,

evaluation, and management of high blood pressure (BP) in adults occurred in

2017, as a collaborative effort between the American College of Cardiology (ACC)

and the American Heart Association (AHA) (Colantonio et al., 2018). According to

this guideline, it is recommended that all individuals classified as adults with

hypertension, as defined by an average systolic blood pressure (SBP) of 130

mmHg or higher, or diastolic blood pressure (DBP) of 80 mmHg or higher, should

receive nonpharmacological therapy.

The JNC 8 guidelines allow for a higher target blood pressure of 130/90

mmHg, in contrast to the JNC 7 guidelines which recommend a target of 120/80

mmHg (Nadig et al., 2022). Additionally, the JNC 8 guidelines suggest reducing

the use of multiple antihypertensive medications. The recently updated guidelines

place increased emphasis on the management of systolic blood pressure (SBP) and

diastolic blood pressure (DBP) through the implementation of treatment cutoffs

that are tailored to individual age groups and specific comorbidities. The newly

implemented guidelines also incorporate additional recommendations aimed at

enhancing the safe utilization of ACEIs and ARBs. In individuals between the ages

of 18 and 59 who do not have significant underlying health conditions, as well as

in individuals aged 60 or above who have diabetes, chronic kidney disease (CKD),

or both, the recommended target blood pressure (BP) level is less than 140/90

mmHg. First-line and subsequent-line treatments should be restricted to four

categories of medications, namely thiazide-type diuretics, calcium channel

blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and

angiotensin receptor blockers (ARBs). The guidelines also take into account the

variable of race and suggest that patients of African descent who do not have

chronic kidney disease (CKD) should be prescribed calcium channel blockers

(CCBs) and thiazides rather than angiotensin-converting enzyme inhibitors

(ACEIs) when commencing therapy. The utilization of ACEIs and ARBs is advised

for all individuals with CKD, irrespective of their ethnic background. This

recommendation applies to both initial treatment options and as supplementary

therapy to initial treatment.