Physicians frequently prescribe antihypertensive medications, guided by the JNC8 Guidelines, to mitigate potential complications. These guidelines, which are widely followed, state that:
1. For patients aged ≥60 years without any comorbidities, treatment is initiated when systolic blood pressure (SBP) is ≥150 mmHg or diastolic blood pressure (DBP) is ≥90 mmHg, with a target BP of <150/90 mmHg.
2. For patients younger than 60 years, or any age with diabetes or chronic kidney disease (CKD), treatment should begin at BP ≥140/90 mmHg, aiming for a target BP of <140/90 mmHg.
3. First-line therapy includes thiazide-type diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs).
In patients with CKD or at risk of acute kidney injury (AKI), ACEIs or ARBs are preferred due to their renal protective effects.
4. If BP goals are not achieved within one month of treatment initiation, either increase the dose of the current medication or add another first-line agent.
5. If blood pressure remains uncontrolled with two drugs, add a third first-line agent.
If three-drug therapy fails or is contraindicated, consider using agents from other antihypertensive classes such as beta-blockers, mineralocorticoid receptor antagonists (MRAs), hydralazine, or central alpha-2 agonists (e.g., clonidine).
MBH/PS
JNC8 keeps treatment straightforward while tailoring it for age, diabetes, and CKD.