New guidelines for the silent killer

Hypertension is a leading cause of cardiovascular disease (CVD) and affects nearly one third of U.S adults. According to the CDC Morbidity and Mortality Report (MMWR), which tracked information from 2003 to 2010, it found disparities in hypertension between African Americans and their white counterparts.

The proportion of persons who were aged < 65 years was greater for African Americans (74.1 percent) compared to whites (57.4 percent). Health-care coverage for those with uncontrolled hypertension was African-Americans (77.7 percent) compared to whites (89.4 percent).

In December 2013 the Joint National Committee of Hypertension (JNC) released its eighth report-the first update in a decade. JNC8 are the new guidelines to treat hypertension and are much simpler than JNC7.

JNC7 classified BP into normal (<120/80), pre-hypertension (120/80 to <140/90), stage 1 (140/90 to <160/100) and stage 2 (>160/100). Treatment began with lifestyle modifications at the pre-hypertension stage and adding medications at each stage. The choice of medication was based on other disease states the individual had.

Hypertension, Chart, healthJNC8 has eliminated the stages. Its recommendations are age based and less stringent. For 60 years and older patients, it is recommended to treat them when systolic blood pressure >150 and diastolic >90.

For adults younger than 60 years of age (18 to 59 years) JNC8 recommends treating blood pressure >140/90. For patients with chronic kidney disease (CKD) and diabetes mellitus (DM), JNC8 recommends treating patients age 18 to 69 years who have blood pressure >140/90. JNC8 stresses the importance of diet and exercise.

For medication treatment JNC8 initiates therapy with a thiazide diuretic (hydrochlorathiazide, chlorthalidone, metolazone, indapamide), angiotensin-converting enzyme inhibitor (ACE inhibitors end in “pril” such as enalapril and lisinopril), angiotensin receptor blockers (ARB such as losartan and valsartan) or calcium channel blockers (CCB such as nifedipine and felodipine).

For most blacks JNC8 recommends a thiazide diuretic and CCBs as first line therapy. For patients with chronic kidney disease regardless of race, JNC8 calls for either and ACEI or an ARB as first line to prevent progression of end stage renal disease.

The new guidelines include three distinct methods of choosing antihypertensive medications, none of which have demonstrated better outcomes than any other.

It is very important to visit your primary care provider for regular checkups and guidance on how to properly control your blood pressure. Control of blood pressure helps reduce the risk of stroke, heart disease and complications of other disease states such as diabetes.

Dr. Charlie W. Colquitt is the Associate Professor of Pharmacy Practice at Florida A & M University, College of Pharmacy and provides services for Community Health Centers of Pinellas, Inc.

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