JNC * 8 Jim Hoehns, Pharm.D.
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Transcript JNC * 8 Jim Hoehns, Pharm.D.
Randomized controlled trials
Adults ≥ 18 years old with hypertension
N >100
Duration: ≥ 1 year
Outcomes
Mortality, CVD related-mortality, CKD-related mortality
MI, HF, hospitalization-HF
Coronary or other revascularization
ESRD
▪ KF resulting in dialysis or transplantation, doubling of Cr value, halving
of GFR
In adults with HTN,
Does initiating antihypertensive drug therapy at
specific BP thresholds improve health outcomes?
Does treatment with antihypertensive drug
therapy to a specified goal lead to improvement in
health outcomes?
Do various antihypertensive drugs or drug classes
differ in comparative benefits and harms on
specific health outcomes?
• 45 y.o. white female
• Hx: HTN, hyperlipidemia, MDD
• Meds: Atorvastatin 20mg QD, Fluoxetine 20mg QD
• BP: 150/96, HR: 73
Treatment:
1. Lisinopril 10mg QD
2. Amlodipine 5mg
3. HCTZ 12.5-25mg QD
4. Metoprolol BID
0
0
0
0
10
•64 y.o. white male
• Hx: CKD, HTN, hyperlipidemia
• Meds: simvastatin 20mg QD, ASA 81mg QD,
lisinopril 20mg QD
• Labs: Cr = 1.9, K+ = 4.8, Est Clcr = 38 ml/min
• BP: 152/94, HR: 68
Treatment:
1.
2.
3.
4.
HCTZ 12.5-25mg QD
Amlodipine 5mg QD
Losartan 50mg QD
Increase lisinopril to
40mg QD
0
0
0
0
10
•56 y.o. black male
• Hx: diabetes, HTN, obstructive sleep apnea
• Meds: metformin 1000mg BID, ASA 81mg QD,
Gluctotrol XL 10mg QD
• Labs: Cr = 1.0
• BP: 148/88, HR: 70
• Treatment:
1. lisinopril 10mg QD
2. losartan 50mg QD
3. HCTZ 12.5-25mg QD
4. Furosemide 20mg QD
0
0
0
0
10
•67 y.o. white male
•Hx: HTN, DM, hyperlipidemia, GERD, BPH
•Meds: finasteride 5mg QD, Zocor 80mg QD, terazosin
10mg QD, glimepride 4mg QD, Actos 45mg QD, lisinopril
10mg QD, metformin XR 2000mg/d, ASA 81mg QD
•Labs: Cr: 1.2, microalbumin 10mg/L, K+ = 4.3
•BP: 160/88,HR: 57
Treatment
1.
2.
3.
4.
HCTZ 12.5-25mg QD
Hydralazine 25mg BID
Diltiazem XR 180mg QD
Increase lisinopril to
20mg QD
0
0
0
0
10
•77 y.o. female
•Hx: HTN, osteoporosis, angina, GERD
•Meds: Reclast 5mg Qyear, Prilosec 40mg QD, Toprol XL
100mg QD, ASA, lisinopril/HCTZ 20/25mg QD
•BP: 169/66, HR: 57, weight: 100 lbs, Cr = 0.3, K+ = 4.2
Treatment:
1. Terazosin
2. Amlodipine
3. Hydralazine
4. Furosemide
0
0
0
0
10
•78 y.o. female
•Hx: Afib (c/o palpitations), HTN
•Meds: warfarin, metoprolol 100mg BID, losartan
50mg QD
•BP: 154/82 HR: 90
Treatment
1. Amlodipine
2. Diltiazem XR
3. Spironolactone
4. Furosemide
0
0
0
0
10
•66 y.o. black male
• Hx: HTN, s/p MI 2 months ago, hyperlipidemia
• Meds: atorvastatin 20mg QD, ASA 81mg QD,
Plavix 75mg QD, HCTZ 25mg QD, metoprolol
100mg BID
• BP: 152/92, HR: 62
Treatment
1. Amlodipine
2. Lisinopril
3. Diltiazem XR
4. Furosemide
0
0
0
0
10
•66 y.o. male
•Hx: CKD, HTN, diabetes, PAD, hypothyroidism,
hyperlipidemia
•Meds: ASA 81mg QD, Lantus + Humalog, levothyroxine
0.1mg QD, Crestor 20mg QD, lisinopril 20mg QD
•Labs: Cr = 2.8, K+ = 4.8
•BP: 150/92, HR: 68
Treatment
1. atenolol
2. amlodipine
3. HCTZ
10
4. hydralazine
0
0
0
0
•70 y.o. male
•Hx: HTN, LVH, GERD, TIA
•Meds: Plavix 75mg QD, famotidine 20mg QD,
HCTZ 25mg QD
•BP: 154/86, HR: 70
Treatment
1. Metoprolol
2. Lisinopril
3. Amlodipine
4. Spironolactone
0
0
0
0
10
•62 y.o. female
•Hx: COPD, HTN, OA, obesity, CAD, occ symptomatic
angina
•Meds: Spiriva, Advair, ASA, Imdur 90mg QD, lisinopril
40mg QD, metoprolol XL 100mg QD, Nitrostat PRN
•BP: 152/90, HR: 64
Treatment
1. HCTZ
2. valsartan
3. amlodipine
4. terazosin
0
0
0
0
10
Age ≥ 60: goal BP is <150/90
Age <60: goal BP is <140/90
First line therapies
Thiazide, CCB’s, ACEI, ARB
Thiazide or CCB recommended over ACEI in
blacks with diabetes
Beta-blockers: not recommended as first line
therapy