[1] Hypertension CPG (JNC 8, NICE 2014)

Question 1

Main differences of JNC 7 from JNC 8

Answer 1

JNC7:

1. Defined HPN and Pre-HPN
2. Separate treatment goals for “uncomplicated” HPN and other subsets
3. Recommended 5 classes of drugs but recommended thiazide diuretics as initial Tx

JNC8:

1. Definitions of HPN and Pre-HPN not addressed
2. Similar treatment goals defined
3. Recommended selection from 4 classes of drugs

Question 2

Hypertension Diagnosis (Clinical Visits)

Answer 2

At least 3 visits
Stage 1: BP >= 140/90
Stage 2: BP >= 140/90

Question 3

Hypertension Diagnosis (Home BP or Ambulatory BP Monitoring)

Answer 3

Stage 1: BP >= 135/85

Stage 2: BP >= 150/95

Question 4

According to the NICE 2011 Guidelines when using Home Blood Pressure Monitoring, these points must be ensured (5)

Answer 4

1. Each BP recording must have two consecutive measurements taken, at least a minute apart
2. Person must be seated
3. BP is recorded twice daily, ideally one in morning and one in the evening
4. BP recording continues for at least 4 days, ideally for 7 days
5. Measurement of the first day is discarded and the average value of the remaining measurements are used to confirm a diagnosis of HPN

Question 5

According to the NICE 2011 Guidelines, when a measurement has a difference of readings between arms greater than 20 mmHg what should be done?

Answer 5

Repeat measurements
If it remains more than 20mmHg on the second measurement, all subsequent BP readings are to be done on the arm with the higher reading

Question 6

When should you initiate HPN treatment for a patient >= 60 years old

Answer 6

SBP >= 150

DBP >= 90

Question 7

When should you initiate HPN treatment for a patient

Answer 7

SBP >= 140

DBP >= 90

Question 8

When should you initiate HPN treatment for a patient >= 18 years old with CKD

Answer 8

SBP >=140

DBP >=90

Question 9

When should you initiate HPN treatment for a patient >= 18 years old with DM

Answer 9

SBP >=140

DBP >=90

Question 10

Initial Treatment for the General Non-black Population

Answer 10

1. Thiazide Diuretics
2. CCBs
3. ACE inhibitors
4. ARBs

Question 11

Initial Treatment for the General Black Population

Answer 11

1. Thiazide Diuretics

2. CCBs

Question 12

Initial Drug Therapy for Patients with CKD

Answer 12

Initial anti-hypertensive treatment should include an ACEI or ARB to improve kidney outcomes, applies to all patients regardless of race or DM status

Question 13

What should be done if BP goal is not achieved in 1 month of treatment?

Answer 13

1. Increase dose of initial drug

2. Add a second drug

Question 14

What anti-HPN medication classes should not be combined?

Answer 14

ACEI and ARBs

Question 15

Differentiate: Hypertensive Urgency and Hypertensive Emergency according to JNC7 guidelines

Answer 15

Urgency: No end organ damage, can be given oral medications initially and BP may be lowered within 2-3 days

Emergency: Impending or progressive target organ damage, lowering BP no more than 25% of MAP in minutes to an hour

Both have BP greater or equal to 180/120