Eighth Joint National Committee Guidelines Research Articles

Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)

Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Uncontrolled hypertension in a rural population of Jammu and Kashmir

AimEvaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it. MethodsThe study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu.Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines. ResultsA total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement.Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40–60 years (49%), subjects more than 60 years had it in 40%.The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension. ConclusionUncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.

Implementing DASH-aligned Congregate Meals and Self-Measured Blood Pressure in two senior centers: An open label study

Background and aimsCardiovascular Disease (CVD) poses significant health risks for seniors, especially among low-income and minority communities. Senior centers offer multiple services. We tested whether implementing two evidence-based interventions- DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring-lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities. Methods and resultsOpen-label study, enrolling clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. Participants received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Co-Primary outcomes: a) change in systolic BP measured by independent health professionals, and b) change in percent with “controlled BP” (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline. Secondary outcomes: Changes in BP at Months 3 and 5/6 (last measure).We enrolled 94 participants; COVID closures interrupted implementation mid-study. Mean systolic BP at Month-1 changed by −4.41 mmHg (n = 61 p = 0.07) compared to Baseline. Participants with controlled BP increased (15.7%) at Month 1. Change in mean BP at Month 1 was significantly correlated with BMI (p = 0.02), age (p = 0.04), and baseline BP (p < 0.001). Mean systolic SMBP changed by −6.9 mmHg (p = 0.004) at Months 5/6. ConclusionsImplementing an evidence-based multi-component BP-lowering intervention within existing congregate meal programs at senior centers serving minority and low-income communities is feasible, and early findings show promising evidence of effectiveness. This approach to cardiovascular risk reduction should be further tested for widespread adoption and impact.Registered on ClinicalTrials.gov NCT03993808 (June 21st, 2019)

National Trends in Antihypertensive Treatment Among Older Adults by Race and Presence of Comorbidity, 2008 to 2017.

In 2014, hypertension guidelines for older adults endorsed increased use of fixed-dose combinations, prioritized thiazide diuretics and calcium channel blockers (CCBs) for Black patients, and no longer recommend beta-blockers as first-line therapy. To evaluate older adults' antihypertensive use following guideline changes. Time series analysis. Twenty percent national sample of Medicare Part D beneficiaries aged 66 years and older with hypertension. Eighth Joint National Committee (JNC8) guidelines MAIN MEASURES: Quarterly trends in prevalent and initial antihypertensive use were examined before (2008 to 2013) and after (2014 to 2017) JNC8. Analyses were conducted among all beneficiaries with hypertension, beneficiaries without chronic conditions that might influence antihypertensive selection (hypertension-only cohort), and among Black patients, given race-based guideline recommendations. The number of beneficiaries with hypertension increased from 1,978,494 in 2008 to 2,809,680 in 2017, the proportions using antihypertensives increased from 80.3 to 81.2%, and the proportion using multiple classes and fixed-dose combinations declined (60.8 to 58.1% and 20.7 to 15.1%, respectively, all P<.01). Prior to JNC8, the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and CCBs was increasing. Use of CCBs as initial therapy increased more rapidly following JNC8 (relative change in quarterly trend 0.15% [95% CI, 0.13-0.18%), especially among Black beneficiaries (relative change 0.44% [95% CI, 0.21-0.68%]). Contrary to guidelines, the use of thiazides and combinations as initial therapy consistently decreased in the hypertension-only cohort (13.8 to 8.3% and 25.1 to 15.7% respectively). By 2017, 65.9% of Black patients in the hypertension-only cohort were initiated on recommended first-line or combination therapy compared to 80.3% of non-Black patients. Many older adults, particularly Black patients, continue to be initiated on antihypertensive classes not recommended as first-line, indicating opportunities to improve the effectiveness and equity of hypertension care and potentially reduce antihypertensive regimen complexity.

Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

The Nexus Between Adherence to Recommended Lifestyle Behaviors and Blood Pressure Control in Hypertensive Patients at Mutare Provincial Hospital, Zimbabwe: A Cross-Sectional Study.

PurposeTo determine the association between the achievement of blood pressure (BP) control and adherence to recommended lifestyle behaviors among hypertensive patients seen at Mutare Provincial Hospital, Zimbabwe.Patients and MethodsA cross-sectional study was conducted using BP readings from three consecutive months. A structured interviewer-administered and pretested questionnaire with components derived from the World Health Organization Stepwise Survey was employed to extract information from 350 purposively selected participants. Measurement of BP was based on the Eighth Joint National Committee Guidelines. Bivariate and multivariate logistic regression analyses were computed using the SPSS package.ResultsThe mean age of the 350 participants was 67±11.38 years. Males made up 35% of the participants and BP control was achieved in 41.4% of the patients. Only 5.1% of the participants reported adherence to all the recommended lifestyle behaviors. Low adherence rates were reported for diet, medication, and physical activity. Bivariate analysis showed that participants who adhered to antihypertensive treatment and alcohol recommendations had reduced odds of having uncontrolled hypertension, while consuming deep-fat fried foods ≥3 times a week was associated with higher odds of uncontrolled BP (p<0.1). Logistic regression analysis revealed that participants who ate traditional whole-grain “sadza” or porridge were more likely to have controlled BP [adjusted odds ratio (AOR): 1.6; 95% confidence interval (CI): 1.0–2.5] while those who did not add salt at the table had reduced odds of having uncontrolled BP by 40% (AOR: 0.6; 95% CI: 0.4–0.9).ConclusionOverall, adherence to the recommended lifestyle behaviors which are known to be effective in controlling BP in Mutare was poor. Health workers should include comprehensive health education messages on the importance of compliance with dietary, medication, and physical exercise recommendations when counseling patients. The intervention crafting process should focus on identifying enablers of the recommended lifestyle behaviors in the community and the health delivery system.

Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation.

Hypertension guidelines recommend calcium channel blockers (CCBs), thiazide diuretics, and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) as first-line agents to treat hypertension. Hypertension is common among kidney transplant (KTx) recipients, but data are limited regarding patterns of antihypertensive medication (AHM) use in this population. We examined a novel database that links national registry data for adult KTx recipients (age>18years) with AHM fill records from a pharmaceutical claims warehouse (2007-2016) to describe use and correlates of AHM use during months 7-12 post-transplant. For patients filling AHMs, individual agents used included: dihydropyridine (DHP) CCBs, 55.6%; beta-blockers (BBs), 52.8%; diuretics, 30.0%; ACEi/ARBs, 21.1%; non-DHP CCBs, 3.0%; and others, 20.1%. Both BB and ACEi/ARB use were significantly lower in the time period following the 2014 Eighth Joint National Committee (JNC-8) guidelines (2014-2016), compared with an earlier period (2007-2013). The median odds ratios generated from case-factor adjusted models supported variation in use of ACEi/ARBs (1.51) and BBs (1.55) across transplant centers. Contrary to hypertension guidelines for the general population, KTx recipients are prescribed relatively more BBs and fewer ACEi/ARBs. The clinical impact of this AHM prescribing pattern warrants further study.

Prescribing Pattern of Antihypertensive Medications in a Geriatric Center In South Western Nigeria

Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1st January 2017 and 31st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.

ASSESSMENT OF PROFESSIONAL’S ADHERENCE TO JOINT NATIONAL COMMITTEE 8 GUIDELINES IN THE MANAGEMENT OF HYPERTENSION

Objectives: Hypertension is the most insidious ailment in primary care with its management being a daily affair. The avail of antihypertensive medications has affirmed their efficacy in blood pressure alleviation. Yet, the methodical choice of medication with which treatment ought to commence at the precise blood pressure threshold and maintained at a target level was undiscerned. Consequently, the Eighth Joint National Committee grants an evidence-based tool, which was employed in the appraisal of professional’s adherence to joint national committee 8 guidelines.Methods: A prospective, observational study was governed. Aggregate patients with hypertension with/without diabetes mellitus (DM) and/ or chronic kidney failure admitted in general medicine and the dialysis unit of the tertiary health care hospital, for 4 months were enrolled. The rationality of antihypertensive medications and target blood pressure was noted.Results: Patients matriculated to 125, 90 males and 35 females. Average age perceived was between 51 and 60 years, with the length of stay 14.39 (standard deviation [SD]±1.52) and 9.3 (SD±0.46) days in the respective unit. The gross medication endorsed represents 1085 medications, incorporating 337 antihypertensive medications. The optimal choice of an antihypertensive medicine was clonidine and amlodipine. Adherence in the populace with lone hypertension was cent percent, trailed by hypertension with DM 82.35% and minimal in hypertension with chronic kidney disease.Conclusion: 86-medication compiled adherence to the guidelines (25.52%). Rationality of medication depicts 25.6% were rational and 73.6% distinguish as non-rational, amid a demise of a sole victim. A significant high-grade defiance of health-care practitioners to the Eighth Joint National Committee guidelines was evidenced from our study.

ASSESSMENT OF PROFESSIONAL’S ADHERENCE TO JOINT NATIONAL COMMITTEE 8 GUIDELINES IN THE MANAGEMENT OF HYPERTENSION

Objectives: Hypertension is the most insidious ailment in primary care with its management being a daily affair. The avail of antihypertensive medications has affirmed their efficacy in blood pressure alleviation. Yet, the methodical choice of medication with which treatment ought to commence at the precise blood pressure threshold and maintained at a target level was undiscerned. Consequently, the Eighth Joint National Committee grants an evidence-based tool, which was employed in the appraisal of professional’s adherence to joint national committee 8 guidelines.Methods: A prospective, observational study was governed. Aggregate patients with hypertension with/without diabetes mellitus (DM) and/ or chronic kidney failure admitted in general medicine and the dialysis unit of the tertiary health care hospital, for 4 months were enrolled. The rationality of antihypertensive medications and target blood pressure was noted.Results: Patients matriculated to 125, 90 males and 35 females. Average age perceived was between 51 and 60 years, with the length of stay 14.39 (standard deviation [SD]±1.52) and 9.3 (SD±0.46) days in the respective unit. The gross medication endorsed represents 1085 medications, incorporating 337 antihypertensive medications. The optimal choice of an antihypertensive medicine was clonidine and amlodipine. Adherence in the populace with lone hypertension was cent percent, trailed by hypertension with DM 82.35% and minimal in hypertension with chronic kidney disease.Conclusion: 86-medication compiled adherence to the guidelines (25.52%). Rationality of medication depicts 25.6% were rational and 73.6% distinguish as non-rational, amid a demise of a sole victim. A significant high-grade defiance of health-care practitioners to the Eighth Joint National Committee guidelines was evidenced from our study.

Pre-operative hypertension and its risk factors: A cross-sectional study among patients admitted for surgery at a tertiary health care facility of Eastern India

Background: Hypertension (HTN) is one of the most common diagnoses in a primary health care setting and it is one of the important and preventable contributors to disease and death. HTN is considered as an additional risk factor in anesthesia and HTN is of special importance to the anesthetist for various reasons. Tracheal intubation, surgical incision, recovery from anesthesia, and post-operative pain can increase blood pressure (BP). Objectives: This study aims to find out the burden of pre-operative HTN and its risk factors among patients who were admitted for surgical procedures at a tertiary health care facility of Durgapur, West Bengal, India. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, an institution based, observational, and cross-sectional study was conducted from January 2019 to February 2019. A pre-tested, semi-structured schedule was used to collect Clinic Social data. Anthropometric measurements and BP were taken as per the world health organization STEP-wise approach to surveillance guidelines. BP was classified as per “The eighth joint national committee (JNC-8) guidelines. Results: Data were collected from 150 study subjects and were analyzed using SPSS, version 20.0 for windows. The frequency of pre-operative HTN and pre-HTN was found to be 38.0% and 32.0% respectively. As per JNC-8, 34.7% had Stage-1 HTN followed by 32.0% and 3.3% who had pre-HTN and Stage-2 HTN, respectively. Increasing age, male gender, smoking, increasing body mass index, dyslipidemia, and Type 2 diabetes mellitus (T2DM) were significantly associated with a higher frequency of HTN. Conclusion: There is a very high prevalence of pre-operative HTN and pre-HTN. Increasing age, male gender, smoking, overweight, obesity, dyslipidemia, and T2DM were significant risk factors for HTN. Routine screening of HTN should be done in surgical ward to see if there are cases of “white coat” HTN.

Drug utilization among hypertensive patients in the outpatient department of medicine in a tertiary care hospital: A cross-sectional study

ABSTRACTBackground: Hypertension is one of the leading risk factors for cardiovascular, cerebrovascular, and renal disease. Its increasing prevalence and treatment costs influence the prescribing pattern among physicians. Drug utilization studies provide insights into the current prescribing practices and help us facilitate the rational use of drugs. We carried out the present study to assess the pattern of drug utilization in hypertensive patients. Method: Adults seeking treatment for hypertension were recruited. Prescriptions were studied for demographic and drug-use details. The World Health Organization indices for drug utilization were evaluated. The percentage of prescriptions adhering to the recent guidelines was determined. Results: Enalapril was the most commonly prescribed drug. Monotherapy was used in 71.8% of the cases. However, 42% of the cases were newly diagnosed. The ratio of prescribed daily dose and defined daily dose showed underutilization of enalapril and atenolol and overutilization of amlodipine. About 87.5% of the prescriptions adhered to Eighth Joint National Committee guidelines. Most of the medications were available at the hospital pharmacy store and were prescribed by their generic names. Total 65.3% of the concomitant medications were not listed in the World Health Organization essential list of medicines. The average number of drugs prescribed was six. A median cost of 14.6 and 94.5 rupees was spent, respectively, on anti-hypertensive and concomitant medications per encounter. Conclusion: The adherence to the guideline was good. Polypharmacy can be reduced by avoiding the prescription of unnecessary medications and promoting the use of fixed-dose combinations.

Awareness of Eighth Joint National Committee Guidelines in Hypertension Management among Internists in Al-Ahsaa Area

Background: Hypertension is one of the most common conditions seen in primary care and the consequences are fatal if not diagnosed early and managed appropriately. Patients want to be sure that hypertension management will decrease their disease burden, and clinicians need guidance on hypertension treatment using the best scientific evidence. Objective: The primary objective is to evaluate the awareness of the Eighth Joint National Committee Guidelines among internists in the Al-Ahsaa area.&#x0D; Method: This was a cross-sectional observational study that evaluated 43 internists randomly chosen in Al-Ahsaa area by using a questionnaire containing 16 questions that reflect on their awareness of the Eighth Joint National Committee Guidelines. Passing 80% of the 16 questions is described as fair awareness of the Eighth Joint National Committee Guidelines.&#x0D; Results: The average of right answers percentages among the 43 evaluated internists was 54.07% ± 25.6%. The averages of right answers percentages among 16 physicians, 14 specialists and 13 consultants were 75.78% ± 20%, 47.76% ± 16% and 34.13% ± 20%, respectively, which showed a significant difference (P-value &lt; 0.00001) between them.&#x0D; Conclusion: The awareness of the Eighth Joint National Committee Guidelines among internists in Al-Ahsaa area is not good enough. However, physicians showed significantly better awareness of the Eighth Joint National Committee Guidelines than specialists and consultants. Increasing the awareness of internists about new guidelines for hypertension is highly recommended, through workshops that could be provided by the Ministry of Health.

A prospective study of the association between total sleep duration and incident hypertension.

The aim of this prospective study was to evaluate total sleep duration as a potential risk factor for the development of hypertension after a mean of 2.6years of follow-up. The study participants comprised 1715 Korean adults aged 40 to 70years. The participants were without hypertension at baseline (2005-2008) and during follow-up (2008-2011) to determine the incident cases of hypertension. Based on a self-reported questionnaire, the individuals were stratified according to total sleep duration (<6hours, 6-7.9hours, 8-9.9hours, ≥10hours). Hypertension was defined according to the Eighth Joint National Committee (JNC 8) guidelines. After an average of 2.6years of follow-up, 164 (9.56%) participants developed hypertension. In multivariate adjusted models, the odds ratio for new-onset hypertension was 1.71 (95% confidence interval, 1.01-2.89) in participants with a short sleep duration (<6hours) compared with those who reported 6 to 7.9hours of sleep. Long sleep duration (more than 8hours) did not have any significant difference on incident hypertension. Among middle-aged and elderly Korean adults, short sleepers were independently associated with a higher risk of developing hypertension.

Estimated Effects of BP Lowering with JNC 8 vs. SPRINT Goals

The 2014 Eighth Joint National Committee (JNC 8) guidelines set blood pressure (BP)-lowering goals of <150/90 mm Hg for adults aged ≥60 years and

Observed Blood Pressure and Mortality Among People Aged 65 Years and Older: A Community-Based Cohort Study

ObjectivesThe 2014 Eighth Joint National Committee guidelines for hypertension management emphasize the upper limit of blood pressure (BP) as the target for treatment in the elderly population. Given the uncertainty regarding optimal BP range, we aimed to investigate the association between observed BP and subsequent mortality in older people. Design, setting, and participantsWe extracted data from 128,765 participants ≥65 years of age who underwent annual health examinations in a retrospective, observational community-based study from 2001 to 2010. Seated BP was measured using an oscillometric device. The outcomes were all-cause and cardiovascular mortality. ResultsAs compared to participants with systolic BP at 130 to 139 mm Hg, the risk of all-cause mortality was significantly higher among those with <110 (adjusted hazard ratios [aHRs], 1.12; 95% confidence interval [CI], 1.05-1.20), 140 to 149 (aHR, 1.08; 95% CI, 1.03-1.14), 150 to 159 (aHR, 1.07; 95% CI, 1.01-1.17), 160 to 169 (aHR, 1.11; 95% CI, 1.04-1.19), and ≥170 mm Hg (aHR, 1.25; 95% CI, 1.17-1.33), whereas the differences were not significant for those with 110 to119 (aHR, 1.06; 95% CI, 1.00-1.12) and 120 to 129 mm Hg (aHR, 1.03; 95% CI, 0.97-1.08). Similarly, diastolic BP at 40 to 79 mm Hg was associated with the lowest risk of all-cause mortality. The J-shaped curve relationship between BP and cardiovascular mortality was also observed. ConclusionsObserved systolic and diastolic BP other than 110 to 139 and 40 to 79 mm Hg, respectively, were associated with a worse outcome. Our large cohort study supports the J-shaped mortality with observed BP in older people.

Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.

The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.

Blood Pressure Goals and Targets in the Elderly.

The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document on hypertension in the elderly recommends that the blood pressure be reduced to less than 140/90mmHg in adults aged 60-79years and the systolic blood pressure to 140 to 145mmHg if tolerated in adults aged 80years and older. I strongly support these guidelines based on clinical trial data, especially from the Systolic Hypertension in the Elderly trial and from the Hypertension in the Very Elderly trial (HYVET). Other guidelines supporting reducing the blood pressure to less than 140/90mmHg in adults aged 60 to 79years of age include the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines, the minority report from the 2013 Eighth Joint National Committee (JNC 8) guidelines, the 2013 Canadian Hypertension Education Program guidelines, the 2011 UK guidelines, the 2014 American Society of Hypertension (ASH)/International Society of Hypertension (ISH) guidelines, and the 2015 AHA/ACC/ASH scientific statement on treatment of hypertension in patients with coronary artery disease. I support these guidelines. In adults aged 80years and older, a blood pressure below 150/90mmHg has been recommended by these guidelines, with a target goal of less than 140/90mmHg considered in those with diabetes mellitus or chronic kidney disease. I support these guidelines. The 2013 JNC 8 guidelines recommend reducing the blood pressure to less than 140/90mmHg in adults aged 60years and older with diabetes mellitus or chronic kidney disease but to less than 150/90mmHg in adults aged 60years and older without diabetes mellitus or chronic kidney disease. I strongly disagree with this recommendation and am very much concerned that the higher systolic blood pressure goal recommended by JNC 8 guidelines in adults aged 60years and older without diabetes mellitus or chronic kidney disease will lead to an increase in cardiovascular events and mortality in these adults.

Medical Management of Atherosclerotic Risk Factors in Vascular Surgery Patients

There is an epidemic of cardiovascular disease in the United States, which is responsible for approximately one death every 40 seconds in the United States. Whereas the overall mortality attributable to cardiovascular disease is decreasing, the overall prevalence of atherosclerotic risk factors is increasing. Optimal management of atherosclerotic risk factors can have profound effects on morbidity and mortality after vascular surgical procedures. This review covers risk factors for the development of atherosclerosis; the evaluation of patients with vascular disease; management of tobacco abuse, hypertension, hyperlipidemia, diabetes mellitus, and antiplatelet agents; and perioperative medical management concerns in vascular surgery. Tables highlight investigational biomarkers for atherosclerosis, behavioral modification recommendations to be used to improve smoking cessation, Eighth Joint National Committee guidelines for blood pressure management, definitions of high- and moderate-intensity statin therapy, and potential future areas of research. Algorithms lay out the effects of cigarette smoke, the proposed mechanism of statin pleiotropy as it pertains to the vasculature, and the proposed mechanisms of the role of hyperglycemia in atherogenesis. This review contains 3 figures, 6 tables, and 79 references.

Eighth joint national committee (JNC-8) guidelines and the outpatient management of hypertension in the African-American population

Background:Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups.Aim:Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens.Materials and Methods:African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows — Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed.Results:In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage.Conclusion:Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.