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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

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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. Hypertension is the commonest clinical disorder and is a major health problem worldwide.

2. 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.

3. Optimization of drug therapy with 1, 2 or 3 anti hypertensive agents in combination and /or full doses may be necessary .

4. Ambulatory and home B.P. monitoring should be encouraged

5. JNC 8 defined new target goals and has advised first line drugs and later line therapy.

6. 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. Some reports suggest benefit in uncontrolled hypertension with chronic renal failure.

8. 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.