1. JNC 8 2014 Evidence-Based Guideline for the Management of
High Blood Pressure in Adults
Dr. Asif Mehmood R.Ph
Pharm. D

2. HTN patients estimated by 2025
Hypertension (HTN) is a major public health concern, affecting 26% of adults worldwide1
972 million
Number of
people with HTN
worldwide in 20001
60%
Increase in the
number of adults with
HTN globally by 20251
10%
Percent of all global
healthcare spending
attributable to high
blood pressure2
1.6 Billion
HTN patients estimated by 2025
1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet Jan 15-21;365(9455):
2. Gaziano TA, Asaf B, S Anand, et.al. The global cost of nonoptimal blood pressure. J Hypertens 2009; 27(7):
$370 billion
Annual worldwide cost of hypertension2
1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet Jan 15-21;365(9455): Gaziano TA, Asaf B, S Anand, et.al. The global cost of nonoptimal blood pressure. J Hypertens 2009; 27(7):

3. EU Prevalence of Hypertension ~81 Million Adults have elevated Blood Pressure
Patients with HTN
Diagnosed HTN
Treated HTN
EU Patients with HTN 81.0M
Diagnosed HTN 78%
Treated HTN 68%
Uncontrolled HTN 38%
Resistant HTN 9% - $7.2M
Uncontrolled HTN
Lloyd-Jones D: Circulation 2010;121:e46 – e215
Persell SD: Hypertension 2011;57:
HTN=Hypertension

4. Hypertension in Pakistan
% age of Pakistani adults with HTN
18%
%age of Pakistani above 45 years of age
33%
are only adequately controlled HTN Cases.
12.5%
Time to take some serious action
Fahad Saleem et al; Br J Gen Pract June 1; 60(575): 449–450. doi: /bjgp10X502182

5. HTN leads to an increased risk of death from stroke and heart disease8x
Cardiovascular Mortality Risk 4x 2x
Hypertension is a serious health issue
Hypertension significantly increases ones risk of CV mortality
For every 20mm Hg, one doubles their CV mortality risk
CV mortality risk doubles for every 20 mmHg increase in systolic blood pressure.1,2
Systolic BP / Diastolic BP (mmHg)
Chobanian et al. Hypertension 2003;42: ; 2Lancet 2002;360:

6. Risk Factors for Cardiovascular Disease
Smoking
Hyperlipidaemia
High salt intake
Homocysteinaemia
Lack of exercise
Obesity
Diabetes
Alcohol >4pints of beer/day
Genetic

7. Accurate Reading of Blood Pressure
Cuff bladder encircle >80% pts arm
sphygmomanometer
Deflate 2-3mm per second
Siting comfortably
Back supported
Legs uncrossed
Upper arm bared
Arm at heart level
SBP INACCURATELY HIGH IF: patient is supine, crossed legs, arm below the heart, arm unsupported, undersized cuff.
AHA guidelines

8. Questions Guiding the Evidence Review

9. Question-1 Specific BP thresholds for Improvement in health outcomes?
Start of antihypertensive pharmacologic therapy
Improvement in health outcomes?
1) > 160 mm Hg
2) > 150 mm Hg
3) > 140 mm Hg
4) > 130 mm Hg

10. Question-2
Does a specified BP goal lead to improvements in health outcomes?
1) 130/80 mm Hg in a diabetic
2) < 140/90 in an 84 year old female
3) < 140/90 in a patient with CKD
4) < 120/80 in a 38 year old male

11. Question-3 Do various antihypertensive drugs or drug classes
differ in comparative benefits and harms on
Specific health outcomes

12. Level of Recommendation Strength of Recommendation
Grade
Strength of Recommendation A
Strong Recommendation B
Moderate Recommendation C
Weak Recommendation
There is at least moderate certainty based on evidence that there is a small net benefit. D
Recommendation against
There is at least moderate certainty based on evidence that it has no net benefit or that risks/harms outweigh benefits. E
Expert Opinion
(“There is insufficient evidence or evidence is unclear or conflicting, but this is what the committee recommends.”) Net benefit is unclear.
JAMA. 2013;():. doi: /jama

13. JNC 8 (2014 Hypertension Guideline Management Algorithm)
JAMA. 2013;():. doi: /jama
2014 Hypertension Guideline Management Algorithm SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ACEI, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; and CCB, calcium channel blocker.aACEIs and ARBs should not be used in combination.bIf blood pressure fails to be maintained at goal, reenter the algorithm where appropriate based on the current individual therapeutic plan.

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