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    JNC 8 PDF

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    The document summarizes guidelines for screening, diagnosing, and managing hypertension and hyperlipidemia. It reviews recommendations from the US Preventive Services Task Force, JNC8, and 2013 ACC/AHA guidelines. These include screening all adults for high blood pressure, diagnosing hypertension as two elevated readings over several weeks, and treating to a goal of <150/90 mmHg for those over 60 or <140/90 mmHg for others based on risk factors. It also discusses assessing cardiovascular risk and treating blood cholesterol/lipids based on risk level.

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    JNC 8 PDF

    Uploaded by

    cut herlinda
    49 views15 pages
    The document summarizes guidelines for screening, diagnosing, and managing hypertension and hyperlipidemia. It reviews recommendations from the US Preventive Services Task Force, JNC8, and 2013 ACC/AHA guidelines. These include screening all adults for high blood pressure, diagnosing hypertension as two elevated readings over several weeks, and treating to a goal of <150/90 mmHg for those over 60 or <140/90 mmHg for others based on risk factors. It also discusses assessing cardiovascular risk and treating blood cholesterol/lipids based on risk level.

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    The document summarizes guidelines for screening, diagnosing, and managing hypertension and hyperlipidemia. It reviews recommendations from the US Preventive Services Task Force, JNC8, and 2013 ACC/AHA guidelines. These include screening all adults for high blood pressure, diagnosing hypertension as two elevated readings over several weeks, and treating to a goal of <150/90 mmHg for those over 60 or <140/90 mmHg for others based on risk factors. It also discusses assessing cardiovascular risk and treating blood cholesterol/lipids based on risk level.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views15 pages

    JNC 8 PDF

    Uploaded by

    cut herlinda
    The document summarizes guidelines for screening, diagnosing, and managing hypertension and hyperlipidemia. It reviews recommendations from the US Preventive Services Task Force, JNC8, and 2013 ACC/AHA guidelines. These include screening all adults for high blood pressure, diagnosing hypertension as two elevated readings over several weeks, and treating to a goal of <150/90 mmHg for those over 60 or <140/90 mmHg for others based on risk factors. It also discusses assessing cardiovascular risk and treating blood cholesterol/lipids based on risk level.

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    of 15

    JNC8 and Current Guidelines

    for Blood Pressure and


    Cholesterol Management

    May 12, 2014


    Presented by
    Martha White, BSN MBA
    Technical Advisor
    Alliant GMCF

    5/14/2014 1
    Objectives
    ► Review the current hypertension screening
    guidelines
    ► Discuss the JNC8 Hypertension Management
    Guidelines
    ► Review current cardiovascular risk assessment
    ► Discuss the 2013 ACC/AHA Hyperlipidemia
    Guidelines
    Blood Pressure Basics
    BP = CO x TPR
    Blood Pressure = Cardiac Output x
    Total Peripheral Resistance

    CO = Stroke Volume x Heart


    Rate = the amount of blood
    pumped by the heart per
    minute

    TPR = the resistance to blood


    flow through the vascular
    system
    Screening for Hypertension
    ► The U.S. Preventive Services Task Force
    (USPSTF) recommends screening for high
    blood pressure in adults aged 18 and older.
    (This is a grade "A" recommendation)
    ► Screen:
    – Every 2 years - blood pressure less than
    120/80 mm Hg
    – Yearly - systolic 120 -139 mm Hg or diastolic
    80 - 89 mm Hg
    U.S. Preventive Services Task Force. Screening
    for high blood pressure: U.S. Preventive Services
    Task Force recommendation statement. Ann
    Intern Med 2007:147-783-786.
    Screening for Hypertension (cont’d)
    ► Hypertension diagnosed - 2 or more elevated
    readings on at least 2 visits over a period of 1
    to several weeks
    ► Hypertension definition - adults with:
    – Systolic - of 140 mmHg or higher or
    – Diastolic - of 90 mmHg or higher

    U.S. Preventive Services Task Force.


    Screening for high blood pressure: U.S.
    Preventive Services Task Force
    recommendation statement. Ann Intern
    Med 2007:147-783-786.
    Factors for Selecting Therapy for
    Hypertension Management
    ► Age
    ► Race
    ► Diabetes
    ► Kidney disease
    ► Cost
    ► Side effect profile
    Lifestyle Management For Hypertension
    ► Weight loss ► DASH diet
    ► Stress management ► Reduce sodium

    ► Reduction of alcohol
    (<1500mg/day)
    ► Increase physical
    intake – if consuming
    >20 drinks per week activity
    – 3 to 4 sessions a week,
    – lasting on average 40 minutes
    U.S. Preventive Services Task Force. Screening for per session, and
    high blood pressure: U.S. Preventive Services Task – involving moderate to vigorous
    Force recommendation statement. intensity physical activities
    Ann Intern Med 2007:147-783-786.

    Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC


    Guideline on Lifestyle Management to Reduce
    Cardiovascular Risk, doi:
    0.1016/j.jacc.2013.11.003.
    JNC8 Hypertension Guideline
    Management Algorithm
    Age 60,+ Age <60 Any Age Any Age
    +DM, -CKD +CKD, +/-DM

    BP Goal BP Goal BP Goal BP Goal


    <150/<90 <140/<90 <140/<90 <140/<90

    Non-black Black All races

    Initiate thiazide or ACEI or Initiate thiazide or Initiate ACEI or ARB, alone


    ARB or CCB, alone or CCB, alone or combo or combo w/other class
    combo

    ACEI = ACE Inhibitor ARB = Angiotensin Receptor Blocker CCB = Calcium Channel Blocker

    Adapted from James PA, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth
    Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.
    Cardiovascular Risk Assessment
    ► Risk factors – age, LDL-C, total and HDL-
    cholesterol, systolic BP, treatment status for
    hypertension, diabetes, current smoking status
    ► Applicable populations for risk calculator:
    – Non Hispanic Whites and African American
    – Age 40-79 (10 year risk)
    – Men and women
    ► Assess every 4-6 years if no ASCVD
    Cardiovascular Risk Assessment
    ► Calculation of 10-year risk for first hard ASCVD
    event:
    – Non-fatal myocardial infarction
    – CHD death
    – Fatal or non-fatal stroke
    ► Risk calculator not appropriate for those with
    known ASCVD
    http://tools.cardiosource.org/ASCVD-Risk-Estimator/
    Lifestyle Management for
    Reducing CV Risk
    ► Diet :
    – High in fruit and veggies, whole grains; low fat; limit
    sweets
    – DASH diet
    ► Physical activity:
    – 3 to 4 sessions a week, lasting on average 40
    minutes per session,
    – involving moderate-to-vigorous intensity physical
    activity.
    Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC
    Guideline on Lifestyle Management to Reduce
    Cardiovascular Risk, doi: 0.1016/j.jacc.2013.11.003.
    2013 ACC/AHA Guidelines on the
    Treatment of Blood Cholesterol
    Clinical No LDL-C ≥ No Diabetes
    ASCVD 190 mg/dL Age 40 - 75
    Yes Yes No Yes

    No Yes
    High Intensity
    10 Year
    Yes
    ASCVD Risk >
    Age > 75 or 7.5%
    Moderate Intensity
    Yes No

    ASCVD = Atherosclerotic
    cardiovascular disease
    Adapted from Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the
    American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Nov 12. [Epub ahead of print].
    References
    ► U.S. Preventive Services Task Force. Screening for high blood pressure: U.S.
    Preventive Services Task Force recommendation statement. Ann Intern
    Med 2007:147-783-786.
    ► 2014 Evidence-Based Guideline for the Management of High Blood Pressure in
    Adults: Report From the Panel Members Appointed to the Eighth Joint National
    Committee (JNC 8). JAMA. 2014;311(5):507-520.
    doi:10.1001/jama.2013.284427
    ► 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular
    Risk. A Report of the American College of Cardiology/American Heart
    Association Task Force on Practice Guidelines. doi: 0.1016/j.jacc.2013.11.003
    ► ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce
    Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College
    of Cardiology/American Heart Association Task Force on Practice Guidelines.
    Circulation. 2013 Nov 12. [Epub ahead of print].
    ► 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. A Report
    of the American College of Cardiology/American Heart Association Task Force
    on Practice Guidelines. 2013;01.cir.0000437741.48606.98published online
    before print November 12 2013
    This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services
    (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IHPC-14-30

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