Fewer adults will receive BP drugs under JNC8

Under the 2014 BP guideline of the Eighth Joint National Committee (JNC8), antihypertensive therapy will be recommended for significantly fewer adults in the United States, reports a study in the Journal of the American Medical Association.

The researchers used data on 16,372 adults from the National Health and Nutrition Examination Survey between 2005 and 2010 to assess the implications of the JNC8 2014 BP guideline, compared with the previous JNC7 BP guideline. Among younger adults aged 18 to 59, the percentage for whom antihypertensive therapy would be recommended decreased from 20.3 percent under JNC7 to 19.2 percent under JNC8. The decrease was even sharper for those aged 60 or older: from 68.9 to 61.2 percent.

The 2014 blood pressure guideline was also associated with an increase in the proportion of treatment-eligible adults meeting blood pressure targets: from 41.2 to 47.5 percent in those aged 18 to 59 and from 47.5 to 65.8 percent in those aged 60 or older.

Overall, 1.6 percent of adults aged 18 to 59 and 27.6 percent of those aged 60 or older were receiving antihypertensive drugs and meeting more stringent JNC7 targets. Under JNC8, some of these patients would be eligible for less stringent or no BP therapy.

The JNC8 guideline increased the systolic BP treatment goal from less than 140/90 to less than 150/90 mm Hg while increasing the target for patients with chronic kidney disease and diabetes from less than 130/80 to less than 140/90 mm Hg. The new study suggests that in comparison with JNC7, antihypertensive therapy will be recommended for fewer Americans under JNC8.

Under JNC8, more patients will be considered to have met BP targets, especially in those aged 60 and over. More study is needed to determine how the new guideline will affect overall BP levels and the resulting effects on cardiovascular disease outcomes [Navar-Boggan AM, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA 2014; 311:1424–1429].