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1、ClinicalReview&EducationSpecialCommunication2014Evidence-BasedGuidelinefortheManagementofHighBloodPressureinAdultsReportFromthePanelMembersAppointedtotheEighthJointNationalCommittee(JNC8)PaulA.James,MD;SuzanneOparil,MD;BarryL.Carter,PharmD;WilliamC.Cushman
2、,MD;CherylDennison-Himmelfarb,RN,ANP,PhD;JoelHandler,MD;DanielT.Lackland,DrPH;MichaelL.LeFevre,MD,MSPH;ThomasD.MacKenzie,MD,MSPH;OlugbengaOgedegbe,MD,MPH,MS;SidneyC.SmithJr,MD;LauraP.Svetkey,MD,MHS;SandraJ.Taler,MD;RaymondR.Townsend,MD;JacksonT.WrightJr,MD
3、,PhD;AndrewS.Narva,MD;EduardoOrtiz,MD,MPHEditorialpages472,474,andHypertensionisthemostcommonconditionseeninprimarycareandleadstomyocardial477infarction,stroke,renalfailure,anddeathifnotdetectedearlyandtreatedappropriately.AuthorAudioInterviewatPatientswan
4、ttobeassuredthatbloodpressure(BP)treatmentwillreducetheirdiseasejama.comburden,whileclinicianswantguidanceonhypertensionmanagementusingthebestscientificSupplementalcontentatevidence.Thisreporttakesarigorous,evidence-basedapproachtorecommendtreatmentjama.co
5、mthresholds,goals,andmedicationsinthemanagementofhypertensioninadults.Evidencewasdrawnfromrandomizedcontrolledtrials,whichrepresentthegoldstandardforCMEQuizatjamanetworkcme.comanddeterminingefficacyandeffectiveness.Evidencequalityandrecommendationsweregrad
6、edCMEQuestionspage522basedontheireffectonimportantoutcomes.Thereisstrongevidencetosupporttreatinghypertensivepersonsaged60yearsoroldertoaBPgoaloflessthan150/90mmHgandhypertensivepersons30through59yearsofagetoadiastolicgoaloflessthan90mmHg;however,thereisin
7、sufficientevidenceinhypertensivepersonsyoungerthan60yearsforasystolicgoal,orinthoseyoungerthan30yearsforadiastolicgoal,sothepanelrecommendsaBPoflessthan140/90mmHgforthosegroupsbasedonexpertopinion.Thesamethresholdsandgoalsarerecommendedforhypertensiveadult
8、swithdiabetesornondiabeticchronickidneydisease(CKD)asforthegeneralhypertensivepopulationyoungerthan60years.Thereismoderateevidencetosupportinitiatingdrugtreatmentwithanangiotensin-convertingenzymeinhibitor,an