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Hypertension Guidelines
Date
JNC
JNC 7
2003
JNC 8
2013
NICE Guidelines
NICE Guidelines
2011
ESC / ESH Hypertension Guidelines
ESC Guideline
2007
Reappraisal of 2007 Hypertension
Guidelines
September 2009
 The JNC 8 guidelines released towards the end of 2013, had several
new things to offer
 One highly discussed recommendation was that for patients aged 60
or above who don’t have DM and CKD, the target BP of 150/90 (instead
of 140/90)…
 The American society of hypertension and the European society for
hypertension have stuck to the previous guidelines of 140/90.While BP of
150/90 may be acceptable, there is a consensus on evidence that with a
target of 140/90 we are more sure about the reduction in risk of CVD and
 For patients between 18 to 59 years and those who not have DM and
CKD,the target BP is 140/90.
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1. Not evidence based recommendation
2. Recommendations by expert opinion only
3. Not unanimous, 5 members of the panel have disagreed
4. All societies have not accepted those recommendations
5. Some what controversial
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SYMPLICITY
HTN-3
SYMPLICITY
HTN-4
Randomized
Yes
Yes
Controlled
Yes
Yes
Blinded
Yes
Yes
Number of subjects
More than 500
More than 500
Number of Centers
Participating
Up to 90 in the US
Up to 100 in the US
Blood Pressure
Required for
Inclusion
> 160 mmHg
Systolic
140-160 mmHg
Systolic
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1.
2.
3.
Hypertension is the commonest clinical disorder and
is a major health problem worldwide.
Inadequately controlled or uncontrolled hypertension
leads to subclinical organ damage which can be
progressive, leading to serious cardiovascular events
like angina, MI and CHF, TIA and stroke, chronic
renal failure, peripheral vascular disease and
retinopathy.
Optimization of drug therapy with 1, 2 or 3 anti
hypertensive agents in combination and /or full doses
may be necessary .
4.
5.
6.
Ambulatory and home B.P. monitoring should
be encouraged
JNC 8 defined new target goals and has
advised first line drugs and later line therapy.
Renal denervation therapy initially showed
significant promise but in randomized blind
trials with sham procedures, there was no
significant difference in the B.P. levels upto 6
month in RDT vs control patients.
7.
8.
Some reports suggest benefit in uncontrolled
hypertension with chronic renal failure.
Life style modification, reduced salt intake
prevention of diabetes and obesity, cessation
of smoking and use of appropriately tailored
drug therapy can prevent end organ
catastrophies.