Friday, December 20, 2013


Finally the JNC 8 guidelines have seen print, but it comes out in a rather unusual manner. I am not quite sure what is the intrigue behind the formulation and writing of these guidelines. Not that it is any business of ours, or that it matters to me and my patients.
Well, just for gossip sake, JNC committee under the auspices of the NHBLI, started their work in 2008, to formulate JNC 8 which was to replace the rather strict and detailed JNC 7 ( otherwise call JNC complex ).
Having struggled internally for 5 years and still not sign of it appearing for us simple people, in Jan 2013, NHLBI decided that they will not lend their name to this document and asked the societies, namely the American Heart Association and the American College of Cardiology to write the final paper and publish under the society names.
Well, the societies refused and the committee members also refused to published under the society. ( see in America you even have gridlock over scientific documents ( not only in Washington ).
So now we see members of the committee publishing the document JNC 8 on their own in Journal of the American Medical Association and the AHA and ACC publishing their own documents. The AHA and ACC called theirs advisory statements.Of course the European Society of Cardiology ( across the pond ), had already release their our guidelines. In fact the JNC 8 looks a bit like the ESC guidelines. To further increase the intrique, one day before the JNC 8 was published, the American Society of Hypertension and the International Society of Hypertension released their own guidelines. Some of the authors of this ASH / ISH guidelines were also committee members of JNC 8. Some were members of the previous JNC 7. It is getting quite confusing.
Even more upsetting is the fact that JNC 8 reviewed all clinical trial papers up till 2009, which means that by 2013, they are outdated. JNC 8 is late. The committee tried to mitigate by doing a abridged review. Poor effort. Basically, JNC 8, late is outdated.
Be that as it may, mortals like us like to have some references not that we follow them whole sale or even closely.
I suppose it is good to have an algorithm to guide us.

Image not available.

What then are the main differences between JNC 7 and JNC 8? Basically, JNC 8 looks like a simplified account of JNC 7. They have made it simpler.

Image not available.
Well in summary, there are two. Firstly, for the elderly, get them to 150/90 mmHg would be sufficient. Secondly, You need not start with a diuretic as firstline. You could also use a CCB or ACE-I or ARB.

For those who would like the original article, you can find it in JAMA.. James PA, Oparil S, Carter BL, 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; DOI:10.1001/jama.2013.284427. Available at:

I suppose it is better late and never. JNC -late.

No comments: