JNC * 8 Jim Hoehns, Pharm.D.

Report
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Randomized controlled trials
Adults ≥ 18 years old with hypertension
N >100
Duration: ≥ 1 year
Outcomes
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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
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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
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Age ≥ 60: goal BP is <150/90
Age <60: goal BP is <140/90
First line therapies
 Thiazide, CCB’s, ACEI, ARB
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Thiazide or CCB recommended over ACEI in
blacks with diabetes
Beta-blockers: not recommended as first line
therapy

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