Hypertension update, JNC8 and beyond

- This review highlights development of JNC guidelines for the treatment of hypertension from JNC 1, published in 1977, to JNC 8, published in 2014.
- The review compares JNC 7 and 8. JNC 8 was designed to improve the guidelines. However, it generated a great deal of controversy.
- The controversial issues are discussed. The most being the blood pressure level at which treatment should be initiated.
- Pharmacogenomics including genes involved in the response to beta blockers and thiazide diuretics are identified and GWAS results are reviewed.
- The review suggests treatment may be improved by integrative patient care including patient education and therapeutic interventions.

Hypertension is the most preventable major risk factor for cardiovascular morbidity and mortality. The etiology of elevated blood pressure is a complex process involving the interaction of genetics, demographics, comorbid disorders, and environmental influences. Effective hypertensive therapy has been shown to reduce cardiovascular morbidity and mortality. JNC reports have served as a valuable source of guidelines, and JNC 8 is the most recently updated guideline for the prevention, diagnosis, and treatment of hypertension. It includes modification of JNC 7 regarding the threshold for therapy, therapeutic goals, and medications or combinations of medications that differ in benefits for certain patient populations. However, JNC 8 generated a significant degree of controversy. This review will evaluate JNC 7 versus JNC 8 guidelines and discuss the most controversial aspects of JNC 8 through a therapeutic perspective. This review will also discuss the most recently available evidence that has an impact on the JNC 8 recommendations. Despite the nuance of clinical guidelines, blood pressure control rates remains suboptimal. We will explore potential reasons and solutions for this dilemma including pharmacogenomics, novel risk-stratification strategies, lifestyle interventions, and integrative care.