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JNC8 and Current Guidelines

for Blood Pressure and


Cholesterol Management

May 12, 2014


Presented by
Martha White, BSN MBA
Technical Advisor
Alliant GMCF
5/14/2014

Objectives

Review the current hypertension screening


guidelines

Discuss the JNC8 Hypertension Management


Guidelines

Review current cardiovascular risk assessment

Discuss the 2013 ACC/AHA Hyperlipidemia


Guidelines

Blood Pressure Basics


BP = CO x TPR
Blood Pressure = Cardiac Output x
Total Peripheral Resistance
CO = Stroke Volume x Heart
Rate = the amount of blood
pumped by the heart per
minute
TPR = the resistance to blood
flow through the vascular
system

Screening for Hypertension


The U.S. Preventive Services Task Force
(USPSTF) recommends screening for high
blood pressure in adults aged 18 and older.
(This is a grade "A" recommendation)
Screen:
Every 2 years - blood pressure less than
120/80 mm Hg
Yearly - systolic 120 -139 mm Hg or diastolic
80 - 89 mm Hg

U.S. Preventive Services Task Force. Screening


for high blood pressure: U.S. Preventive Services
Task Force recommendation statement. Ann
Intern Med 2007:147-783-786.

Screening for Hypertension (contd)

Hypertension diagnosed - 2 or more elevated


readings on at least 2 visits over a period of 1
to several weeks

Hypertension definition - adults with:


Systolic - of 140 mmHg or higher or
Diastolic - of 90 mmHg or higher
U.S. Preventive Services Task Force.
Screening for high blood pressure: U.S.
Preventive Services Task Force
recommendation statement. Ann Intern
Med 2007:147-783-786.

Factors for Selecting Therapy for


Hypertension Management

Age
Race
Diabetes
Kidney disease
Cost
Side effect profile

Lifestyle Management For Hypertension


Weight loss
Stress management
Reduction of alcohol
intake if consuming
>20 drinks per week

U.S. Preventive Services Task Force. Screening for


high blood pressure: U.S. Preventive Services Task
Force recommendation statement.
Ann Intern Med 2007:147-783-786.

DASH diet
Reduce sodium
(<1500mg/day)
Increase physical
activity

3 to 4 sessions a week,
lasting on average 40 minutes
per session, and
involving moderate to vigorous
intensity physical activities

Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC


Guideline on Lifestyle Management to Reduce
Cardiovascular Risk, doi:
0.1016/j.jacc.2013.11.003.

JNC8 Hypertension Guideline


Management Algorithm
Age 60,+

Age <60

Any Age
+DM, -CKD

Any Age
+CKD, +/-DM

BP Goal
<150/<90

BP Goal
<140/<90

BP Goal
<140/<90

BP Goal
<140/<90

Non-black
Initiate thiazide or ACEI or
ARB or CCB, alone or
combo

Black
Initiate thiazide or
CCB, alone or combo

All races
Initiate ACEI or ARB, alone
or combo w/other class

ACEI = ACE Inhibitor ARB = Angiotensin Receptor Blocker CCB = Calcium Channel Blocker
Adapted from James PA, 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;311(5):507-520. doi:10.1001/jama.2013.284427.

Cardiovascular Risk Assessment

Risk factors age, LDL-C, total and HDLcholesterol, systolic BP, treatment status for
hypertension, diabetes, current smoking status

Applicable populations for risk calculator:

Non Hispanic Whites and African American


Age 40-79 (10 year risk)
Men and women

Assess every 4-6 years if no ASCVD

Cardiovascular Risk Assessment

Calculation of 10-year risk for first hard ASCVD


event:

Non-fatal myocardial infarction


CHD death
Fatal or non-fatal stroke

Risk calculator not appropriate for those with


known ASCVD
http://tools.cardiosource.org/ASCVD-Risk-Estimator/

Lifestyle Management for


Reducing CV Risk

Diet :

High in fruit and veggies, whole grains; low fat; limit


sweets
DASH diet

Physical activity:

3 to 4 sessions a week, lasting on average 40


minutes per session,
involving moderate-to-vigorous intensity physical
activity.
Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC
Guideline on Lifestyle Management to Reduce
Cardiovascular Risk, doi: 0.1016/j.jacc.2013.11.003.

2013 ACC/AHA Guidelines on the


Treatment of Blood Cholesterol
Clinical
ASCVD

No

Yes

LDL-C
190 mg/dL

No

Yes
No

No

Yes

Yes
High Intensity

Age > 75

Yes

Diabetes
Age 40 - 75

10 Year
Yes
ASCVD Risk >
or
7.5%

Moderate Intensity

No

ASCVD = Atherosclerotic
cardiovascular disease
Adapted from Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the
American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Nov 12. [Epub ahead of print].

References

U.S. Preventive Services Task Force. Screening for high blood pressure: U.S.
Preventive Services Task Force recommendation statement. Ann Intern
Med 2007:147-783-786.
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;311(5):507-520.
doi:10.1001/jama.2013.284427
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular
Risk. A Report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. doi: 0.1016/j.jacc.2013.11.003
ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce
Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College
of Cardiology/American Heart Association Task Force on Practice Guidelines.
Circulation. 2013 Nov 12. [Epub ahead of print].
2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. A Report
of the American College of Cardiology/American Heart Association Task Force
on Practice Guidelines. 2013;01.cir.0000437741.48606.98published online
before print November 12 2013

This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IHPC-14-30

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