2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
Paul A. James,Suzanne Oparil,Barry L. Carter,William C. Cushman,Cheryl Dennison-Himmelfarb,Joel Handler,Daniel T. Lackland,Michael L. LeFevre,Thomas D. MacKenzie,Olugbenga Ogedegbe,Sidney C. Smith,Laura P. Svetkey,Sandra J. Taler,Raymond R. Townsend,Jackson T. Wright,Andrew S. Narva,Eduardo Ortiz +16 more
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TLDR
Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, 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.Abstract:
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, 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.read more
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Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies
Lucy Norcliffe-Kaufmann,Horacio Kaufmann,Jose-Alberto Palma,Cyndya A. Shibao,Italo Biaggioni,Amanda C. Peltier,Wolfgang Singer,Phillip A. Low,David S. Goldstein,Christopher H. Gibbons,Roy Freeman,David Robertson +11 more
TL;DR: The range of orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies is reported.
Journal ArticleDOI
Impact of achieved blood pressures on mortality risk and end-stage renal disease among a large, diverse hypertension population.
TL;DR: Both higher and lower treated BP compared with 130 to 139mm Hg systolic and 60 to 79 mm Hg diastolic ranges had worsened outcomes, adding to the growing uncertainty about BP treatment targets.
Journal ArticleDOI
Management of Hypertension in CKD: Beyond the Guidelines
Eric Judd,David A. Calhoun +1 more
TL;DR: This review addresses current management issues in HTN in patients with CKD including altered circadian rhythm of BP, timing of antihypertensive medication dosing, BP targets, diagnostic challenges in evaluating secondary forms of HTN, and the role of salt restriction in CKD.
Journal ArticleDOI
Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.
Adam P. Bress,Brandon K. Bellows,Jordan B. King,Rachel Hess,Srinivasan Beddhu,Zugui Zhang,Dan R. Berlowitz,Dan R. Berlowitz,Molly B. Conroy,Larry J. Fine,Suzanne Oparil,Donald E. Morisky,Lewis E. Kazis,Natalia Ruiz-Negrón,Jamie Powell,Leonardo Tamariz,Jeff Whittle,Jackson T. Wright,Mark A. Supiano,Alfred K. Cheung,William S. Weintraub,Andrew E. Moran +21 more
TL;DR: In this simulation study, intensive systolic blood‐pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness‐to‐pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime.
Journal ArticleDOI
Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
Marjan W. Attaei,Rasha Khatib,Martin McKee,Scott A. Lear,Gilles R. Dagenais,Ehimario U. Igumbor,Khalid F. AlHabib,Manmeet Kaur,Lanthe Kruger,Koon K. Teo,Fernando Lanas,Khalid Yusoff,Khalid Yusoff,Aytekin Oguz,Rajeev Gupta,Afzalhussein Yusufali,Ahmad Bahonar,Raman Kutty,Annika Rosengren,Viswanathan Mohan,Alvaro Avezum,Rita Yusuf,Andrzej Szuba,Sumathy Rangarajan,Clara K Chow,Salim Yusuf,Salim Yusuf,S Rangarajan,K K Teo,C K Chow,Martin O'Donnell,Andrew Mente,Darryl P. Leong,Andrew Smyth,Philip Joseph,S. Islam,M Zhang,W Hu,Chinthanie Ramasundarahettige,G Wong,L Dayal,Amparo Casanova,Mahshid Dehghan,Gayle Lewis,A Aliberti,Anna Reyes,A Zaki,Basil S. Lewis,B Zhang,D Agapay,D Hari,E Milazzo,E Ramezani,Fawaz Al Hussain,F Shifaly,I Kay,J Rimac,J Swallow,L Heldman,Maha Mushtaha,M Trottier,N Aoucheva,N Kandy,Pam Mackie,R Solano,S Chin,S Ramacham,S Shahrook,S Trottier,T Tongana,W Elsheikh,J Lindeman,Matthew J. McQueen,K Hall,Judy L. Keys,X Wang,J Keneth,Anitha Devanath,Rafael Diaz,Andres Orlandini,B Linetsky,S Toscanelli,G Casaccia,JM Maini Cuneo,Omar Rahman,R Yusuf,AK Azad,KA Rabbani,HM Cherry,Adnan Mannan,I Hassan,AT Talukdar,RB Tooheen,Maheer Khan,Mariz Sintaha,Tarzia Choudhury,Rashidul Haque,S Parvin,A Avezum,GB Oliveira,CS Marcilio,A.C. Mattos,K Teo,Jane DeJesus,G Dagenais,P. Poirier,G Turbide,D. Auger,A LeBlanc De Bluts,MC Proulx,M Cayer,N Bonneville,S Lear,Danijela Gasevic,E Corber,V de Jong,I Vukmirovich,Andy Wielgosz,George Fodor,Andrew L. Pipe,A Shane,F Lanas,Pamela Seron,S Martinez,A Valdebenito,Maria Jose Oliveros,Li Wei,Liu Lisheng,Chen Chunming,Wang Xingyu,Zhao Wenhua,Zhang Hongye,JiaXuan,Hu Bo,Sun Yi,Bo Jian,Zhao Xiuwen,Chang Xiaohong,Chen Tao,Chen Hui,Deng Qing,Cheng Xiaoru,He Xinye,Li Jian,Li Juan,Liu Xu,Ren Bing,Wang Wei,Wang Yang,Yang Jun,Zhai Yi,Zhu Manlu,Lu Fanghong,Wu Jianfang,Li Yindong,Hou Yan,Zhang Liangqing,Guo Baoxia,Liao Xiaoyang,Zhang Shiying,BianRongwen,TianXiuzhen,Li Dong,Chen Di,Wu Jianguo,Xiao Yize,Liu Tianlu,Zhang Peng,Dong Changlin,Li Ning,Ma Xiaolan,Yang Yuqing,Lei Rensheng,Fu Minfan,He Jing,Liu Yu,Xing Xiaojie,Zhou Qiang,Patricio Lopez-Jaramillo,PA Camacho Lopez,Ronald G. Garcia,Lja Jurado,Diego Gomez-Arbelaez,JF Arguello,R Dueñas,Stein Silva,LP Pradilla,Fabián Ramírez,Dora I. Molina,C Cure-Cure,Maritza Pérez,E. Hernández,Edgar Arcos,S Fernandez,Claudia Narvaez,J Paez,Aristides Sotomayor,Hector H. Garcia,Gregorio Sánchez,T David,Alvaro Rico,Prem Mony,Mario Vaz,A V Bharathi,Srinivasan Swaminathan,Kiruba Shankar,Anura V Kurpad,KG Jayachitra,Nithin Kumar,Virinder Mohan,Mohan Deepa,K Parthiban,M Anitha,S Hemavathy,T Rahulashankiruthiyayan,D Anitha,K Sridevi,R Gupta,Raja Babu Panwar,Indu Mohan,Prateek Rastogi,Sharad Rastogi,R Bhargava,Rajakumari Ravi Kumar,JS Thakur,Binod Kumar Patro,Pvm Lakshmi,Rajiv Mahajan,P Chaudary,V. Raman Kutty,K Vijayakumar,K Ajayan,G Rajasree,AR Renjini,A Deepu,B Sandhya,S Asha,HS Soumya,Roya Kelishadi,A Bahonar,Noushin Mohammadifard,H Heidari,K Yusoff,Tst Ismail,KK Ng,A Devi,Nadzimah Mohd Nasir,M. Md Yasin,Maizatullifah Miskan,EA Rahman,Mkm Arsad,Farnaza Ariffin,Suraya Abdul Razak,Fadhlina Abd Majid,Najmin Abu Bakar,MY Yacob,Nurshuhada Zainon,R Salleh,Ramli M,NA Halim,SR Norlizan,NM Ghazali,Mohd Arshad,Rosdinom Razali,S. Ali,HR Othman,Cwjcw Hafar,A Pit,N Danuri,F Basir,Sna Zahari,Hussein A. Abdullah,MA Arippin,NA Zakaria,I Noorhassim,MJ Hasni,MT Azmi,MI Zaleha,KY Hazdi,AR Rizam,W Sazman,A Azman,R Khatib,U Khammash,A Khatib,Rita Giacaman,R Iqbal,A Afridi,R Khawaja,A Raza,Khawar Kazmi,Antonio L. Dans,Hu Co,JT Sanchez,L Pudol,C Zamora-Pudol,Lam Palileo-Villanueva,Aquino,C Abaquin,SL Pudol,ML Cabral,Witold Zatonski,A Szuba,Katarzyna Zatońska,Rafał Ilow,M Ferus,Bożena Regulska-Ilow,Dorota Różańska,Maria Wołyniec,KF AlHabib,Ahmad Hersi,T Kashour,H Alfaleh,Mostafa Q Alshamiri,HB Altaradi,O Alnobani,A Bafart,N Alkamel,Mohammed K. Ali,Mahera Abdulrahman,R Nouri,A. Kruger,H H Voster,Aletta E. Schutte,Edelweiss Wentzel-Viljoen,F.C. Eloff,H de Ridder,H Moss,Johan C. Potgieter,AA Roux,Michael S. Watson,G de Wet,Antonel Olckers,Johann C. Jerling,Marlien Pieters,Tiny Hoekstra,Thandi Puoane,Ehi Igumbor,Lungiswa Tsolekile,David Sanders,P. Naidoo,Nelia P. Steyn,Nasheeta Peer,Bongani M. Mayosi,Brian Rayner,V Lambert,Naomi S. Levitt,Tracy Kolbe-Alexander,L Ntyintyane,Gail D Hughes,Rina Swart,Jean Fourie,Moise Muzigaba,S Xapa,N Gobile,K Ndayi,B Jwili,K Ndibaza,Bonaventure Amandi Egbujie,A Rosengren,K Bengtsson Boström,U Lindblad,P Langkilde,A.-M. Gustavsson,M Andreasson,M Snällman,L Wirdemann,K Pettersson,E Moberg,Karen Yeates,J Sleeth,K Kilonzo,A Oguz,Aak Akalin,Kbt Calik,N Imeryuz,A Temizhan,E Alphan,E Gunes,H Sur,Kubilay Karsidag,Sadi Gulec,Yuksel Altuntas,AM Yusufali,Wael Almahmeed,H Swidan,EA Darwish,Ara Hashemi,N Al-Khaja,JM Muscat-Baron,SH Ahmed,TM Mamdouh,WM Darwish,Mhs Abdelmotagali,SA Omer Awed,GA Movahedi,H Al Shaibani,Rim Gharabou,DF Youssef,Azs Nawati,Zar Abu Salah,Rfe Abdalla,SM Al Shuwaihi,MA Al Omairi,OD Cadigal,R.S. Alejandrino,Jephat Chifamba,L Gwaunza,G Terera,C Mahachi,P Murambiwa,T Machiweni,R Mapanga +412 more
TL;DR: The availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development, are assessed.
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TL;DR: Losartan conferred significant renal benefits in patients with type 2 diabetes and nephropathy, and it was generally well tolerated.
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