1. Hypertensive Guidelines
Thomas Haffey, D.O., FACC,FAHA FACOI, FNLA

2. Disclosures
Speaker bureau: Merck
Research: Merck
GSK

3. Clinical Case
F.R

5. Structure of Committee
JNC 8 Sept physicians 2 hour interview with Eduardo Ortiz, MD, MPH (NHBLI physician who choose the panel)

6. Questions
23 original questions from physicians who manage high blood pressure Derived from primary care, nurse practioners and physicians assistants

7. Questions to the JNC 8 panel
1. What level should you treat blood pressure? 2. To what level should it be treated? 3. How do you accomplish that ?

8. Difference between JNC7 and JNC8
Shorter time frame(3-4) More involvement Wider use of data base Consensus vs Evidence based

9. Patient Populations
Age Diabetic Black/nonblack Chronic kidney disease

10. AGE
<18 y/o
not considered
<30 y/o
little or no data

11. AGE 30-59 y/o Diagnose DBP > 90 mmHg Treat < 90 mmHg
Evidence: Grade A

12. AGE
60 to 79 y/o
Treat
SBP<150; DBP < 90 mmHg
Evidence: grade A

13. AGE
80 y/o
based on HYVET

14. Diabetes 18 years or older with diabetes
Initiate therapy to lower SBP at 140 and DBP of90
Goals: SBP<140 ; DBP <90
Evidence level=E (Expert opinion)

15. CKD
Population >18 years old with CKD Initiate therapy SBP >140 DBP >90 Treatment Target: SBP <140 DBP<90 Level of Evidence: Grade E

16. JNC-7vs JNC-8 Effort to derive conclusions based on:
“What does the evidence show ?
(as much as we have it)
Recommendations- What should I do?

17. NHLBI stated Goal
“Develop a guideline based on evidence”

18. “No refills”

19. AHA Guidelines
Built on 11% Level A evidence

20. Purpose Develop a guideline that is based on evidence
Used practically in the clinic
Identify what is not present in the data base
Deliver a document to the NHLBI

21. Nonblack Patients
Initiate Therapy Thiazide-type diuretic Calcium Channel blocker Angiotensin-converting enzyme(ACE) inhibitor Angiotensin receptor blocker (ARB) Level of Evidence : Grade B

22. Black Patients
Thiazide-type diuretic CCB Level of Evidence: General Black population: Grade B Blacks (with Diabetes): Grade C (weak)

23. ADHERENCE Side effects Simplicity
Initial Conversation? Role as an educator
The role of the patient- ?ambulatory BP monitors

25. Lord, keep Your arm around my shoulder and Your hand over my mouth

26.      There was a moment of silence  before the senior lady replied,  "I'm wondering, then,  just how serious is my condition  because this prescription is marked  'NO REFILLS'.."    

27. GETTING OLDER 
A distraught senior citizen  phoned her doctor's office.  "Is it true," she wanted to know, "that the medication  you prescribed has to be taken  for the rest of my life?"    

28. GETTING OLDER
"'Yes, I'm afraid so,"' the doctor told her.