Guidelines for Management of High Blood Pressure in Adults

In 2014, panel members of the Eighth Joint National Committee published the results of their evidence review and deliberations about the prevention, detection, evaluation, and treatment of high blood pressure.

The 2014 guideline offers recommendations for the management of hypertension in:

  • People older or younger than age 60 years
  • People aged ≥18 years with chronic kidney disease
  • People aged ≥18 years with diabetes
  • Black and nonblack populations

2017 ACC/AHA Hypertension Guideline

In 2017 the ACC/AHA and 9 other specialty organizations published an updated hypertension guideline which, among many changes, redefined elevated blood pressure to lower BP levels, enlarging the population considered potential candidates for monitoring and treatment. Learn more here.

2018 ESC/ESH Guideline

In 2018 the ESC/ESH published a guideline which retains the 140/90 threshold definition of hypertension, including for patients with chronic kidney disease (CKD), and emphasizes lifestyle interventions as primary treatment, with consideration of antihypertensive drug therapy only in adults at very high risk, eg with established CVD. In many other respects the 2018 guideline is similar to the 2017 ACC/AHA guideline.

2017 Hypertension Guideline

The 2017 Guideline on Management of High Blood Pressure in Adults

Adam S. Cifu and Andrew M. Davis

JAMA | JAMA Clinical Guidelines Synopsis, November 20, 2017

Implications of the New American College of Cardiology Guidelines for Hypertension Prevalence in India

Nikhil Srinivasapura Venkateshmurthy and Coauthors

JAMA Internal Medicine | Research Letter, August 6, 2018

Estimated Change in Prevalence of Hypertension in Nepal Following Application of the 2017 ACC/AHA Guideline

Gulam Muhammed Al Kibria and Coauthors

JAMA Network Open | Original Investigation, July 13, 2018

Blood Pressure Control—Much Has Been Achieved, Much Remains to Be Done

Lawrence J. Fine and Coauthors

JAMA Cardiology | Editorial, May 23, 2018

The New Hypertension Guidelines: Compelling Population Benefit, Manageable Risk, and Time to Implement

Clyde W. Yancy and Gregg C. Fonarow

JAMA Cardiology | Editor's Note, May 23, 2018

The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults

Paul K. Whelton and Robert M. Carey

JAMA Cardiology | JAMA Cardiology Clinical Guidelines Synopsis, February 21, 2018

The 2017 Hypertension Guideline: What’s New and Different

Paul K. Whelton and Robert M. Carey

JAMA | Viewpoint, November 20, 2017

The 2017 Hypertension Guideline: Highlights for Clinical Practice

Philip Greenland and Eric D. Peterson

JAMA | Editorial, November 20, 2017

Cardiovascular Guideline Skepticism vs Lifestyle Realism?

Philip Greenland

JAMA | Viewpoint, December 14, 2017

Battle of the Heart Societies: Who Is Right--the US or Europe--Regarding How to Manage Hypertension?

Battle of the Heart Societies Part 2: Who Is Right--the US or Europe--Regarding How to Manage Hypertension?

Association of the 2014 and 2017 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults

Managing Hypertension Part 1: Understanding the New AHA/ACC Hypertension Guideline

Managing Hypertension Part 2: Understanding the New AHA/ACC Hypertension Guideline

Related Articles

Association of JNC-8 and SPRINT Systolic Blood Pressure Levels With Cognitive Function and Related Racial Disparity

Ihab Hajjar and Coauthors

JAMA Neurology | Original Investigation, October 2017

Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline

Ann Marie Navar-Boggan and Coauthors

JAMA | Original Investigation, April 9, 2014

Prevalence and Characteristics of Systolic Blood Pressure Thresholds in Individuals 60 Years or Older

Daichi Shimbo and Coauthors

JAMA Internal Medicine | Research Letter, August 2014

Groups Spar Over New Hypertension Guidelines

Mike Mitka

JAMA | Medical News & Perspectives, February 19, 2014

Evidence Supporting a Systolic Blood Pressure Goal of Less Than 150 mm Hg in Patients Aged 60 Years or Older: The Minority View

Jackson T. Wright Jr. and Coauthors

Annals of Internal Medicine | Special Article, April 2014

Related Multimedia

The JAMA Report: Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline

Author Interview: Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline

Recent JAMA Network Hypertension Articles

Treatment of Hypertension: Addressing a Global Health Problem

Arman Qamar and Eugene Braunwald

JAMA | Viewpoint, November 6, 2018

Hypertension—A Public Health Challenge of Global Proportions

Naomi D. L. Fisher and Gregory Curfman

JAMA | Editorial, November 6, 2018

Use of Home Blood Pressure Results for Assessing the Quality of Care for Hypertension

Kevin O. Hwang and Coauthors

JAMA | Viewpoint, November 6, 2018

Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events

Thomas T. van Sloten and Coauthors

JAMA | Original Investigation, November 6, 2018

Out-of-Office Blood Pressure Monitoring in 2018

Sarah Melville and James Brian Byrd

JAMA | JAMA Insights, November 6, 2018

Ambulatory Blood Pressure Monitoring

Tamar S. Polonsky and George L. Bakris

JAMA | JAMA Diagnostic Test Interpretation, November 6, 2018

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension

James P. Sheppard and Coauthors

JAMA Internal Medicine | Original Investigation, October 29, 2018

Association of Clinical and Social Factors With Excess Hypertension Risk in Black Compared With White US Adults

George Howard and Coauthors

JAMA | Original Investigation, October 2, 2018

Association of a Smartphone Application With Medication Adherence and Blood Pressure Control: The MedISAFE-BP Randomized Clinical Trial

Kyle Morawski and Coauthors

JAMA Internal Medicine | Original Investigation, April 16, 2018

Treating Blood Pressure Correctly by Measuring It Correctly

Robert B. Baron

JAMA Internal Medicine | Invited Commentary, April 16, 2018

Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults

Pascal Geldsetzer and Coauthors

JAMA Internal Medicine | Original Investigation, March 2018

Overtreatment of Asymptomatic Hypertension—Urgency Is Not an Emergency: A Teachable Moment

Jeong Yun Yang and Coauthors

JAMA Internal Medicine | Teachable Moment, February 26, 2018

Association Between Microinfarcts and Blood Pressure Trajectories

Jonathan Graff-Radford and Coauthors

JAMA Neurology | Original Investigation, February 2018

Bariatric Surgery Controls Blood Pressure

Anita Slomski

JAMA | Clinical Trials Update, January 23/30, 2018

Blood Pressure Trajectories in the 20 Years Before Death

João Delgado and Coauthors

JAMA Internal Medicine | Original Investigation, January 2018

Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis

Mattias Brunström and Bo Carlberg

JAMA Internal Medicine | Original Investigation, November 13, 2017

The DASH Diet, 20 Years Later

Dori Steinberg and Coauthors

JAMA | Viewpoint, April 18, 2017

Hypertension—A Global Neurological Problem

Jerome H. Chin and Coauthors

JAMA Neurology | Viewpoint, February 6, 2017

Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or Older: A Randomized Clinical Trial

Michelle C. Odden and Coauthors

JAMA Internal Medicine | Original Investigation, February 6, 2017

Hypertension in 2017—What Is the Right Target?

Aram V. Chobanian

JAMA | Viewpoint, January 30, 2017

Highest Blood Pressure Levels Shift From Rich to Poor Countries

M.J. Friedrich

JAMA | Global Health, January 17, 2017

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Mohammad H. Forouzanfar and Coauthors

JAMA | Original Investigation, January 10, 2017

Hypertension Control for 10 Million

News From the Centers for Disease Control and Prevention

JAMA | January 2017

Cost-effectiveness of Intensive Blood Pressure Management

Ilana B. Richman and Coauthors

JAMA Cardiology | Original Investigation, November 2016

Comparing the SPRINT and the HOPE-3 Blood Pressure Trial

Paul K. Whelton and Coauthors

JAMA Cardiology | Viewpoint, November 2016

The SPRINT and the HOPE-3 Trial in the Context of Other Blood Pressure–Lowering Trials

Salim Yusuf and Coauthors

JAMA Cardiology | Viewpoint, November 2016

Effect of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) on Conduction System Disease

Thomas A. Dewland and Coauthors

JAMA Internal Medicine | Original Investigation, August 2016

Hypertensive Urgency—Is This a Useful Diagnosis?

Iona Heath

JAMA Internal Medicine | Invited Commentary, July 2016

SPRINT Results in Older Patients: How Low to Go?

Aram V. Chobanian/p>

JAMA | Editorial, June 28, 2016

Validation of the Instant Blood Pressure Smartphone App

Timothy B. Plante and Coauthors

JAMA Internal Medicine | Research Letter, May 2016

The Burden of Hypertension and Associated Risk for Cardiovascular Mortality in China

Sarah Lewington and Coauthors

JAMA Internal Medicine | Original Investigation, April 2016

Ushering Hypertension Into a New Era of Precision Medicine

Theodore A. Kotchen and Coauthors

JAMA | Viewpoint, January 14, 2016

Blood Pressure Lowering in Type 2 Diabetes: A Systematic Review and Meta-analysis

Connor A. Emdin and Coauthors

JAMA | Original Investigation, February 10, 2015

Patients With Undiagnosed Hypertension: Hiding in Plain Sight

Hilary K. Wall and Coauthors

JAMA | Viewpoint, November 19, 2014

Efficacy of Device-Guided Breathing for Hypertension in Blinded, Randomized, Active-Controlled Trials

Gijs W. D. Landman and Coauthors

JAMA Internal Medicine | Original Investigation, November 2014

Self-titration of Antihypertensive Therapy in High-Risk Patients

Peter M. Nilsson and Fredrik H. Nystrom

JAMA | Editorial, August 27, 2014

Systolic Blood Pressure Levels Among Adults With Hypertension and Incident Cardiovascular Events

Carlos J. Rodriguez and Coauthors

JAMA Internal Medicine | Original Investigation, August 2014

Let’s Prioritize the Right Care for the Right Patients With Hypertension

Paul Arthur James and Coauthors

JAMA Internal Medicine | Invited Commentary, August 2014

Salt Restriction

From The Medical Letter on Drugs and Therapeutics

JAMA | From The Medical Letter on Drugs and Therapeutics, June 4, 2014

Blood Pressure Trajectories in Early Adulthood and Subclinical Atherosclerosis in Middle Age

Norrina B. Allen and Coauthors

JAMA | Original Investigation, February 5, 2014

Resistant Hypertension: A Review of Diagnosis and Management

Wanpen Vongpatanasin and Coauthors

JAMA | Grand Rounds, June 4, 2014

Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care: A Randomized Trial

Laura A. Petersen and Coauthors

JAMA | Original Investigation, September 11, 2013

Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program

Marc G. Jaffe and Coauthors

JAMA | Original Investigation, August 21, 2013

Protocol-Based Treatment of Hypertension: A Critical Step on the Pathway to Progress

Thomas R. Frieden and Coauthors

JAMA | Viewpoint, January 1, 2014

US Trends in Prevalence, Awareness, Treatment, and Control of Hypertension, 1988-2008

Brent M. Egan and Coauthors

JAMA | Original Contribution, May 26, 2010

Read more about Hypertension from the JAMA Network