Evidence-Based JNC 8 Guideline for the Management of High Blood Pressure in Adults

In 2013, 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.

In contrast to the 2003 JNC 7 guideline recommendation, the 2014 guideline is driven by a systematic review of clinical trial evidence.

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

SPRINT trial results may eventually contribute to a revision of JNC8 recommendations, but for now most experts urge a go-slow treatment approach and continued adherence to the 2014 guidelines. This Viewpoint proposes blood pressure treatment thresholds given important trials published after JNC8.

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.

2017 Hypertension Guideline

Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Adam S. Cifu and Andrew M. Davis

JAMA | JAMA Clinical Guidelines Synopsis, November 20, 2017

The 2017 Clinical Practice Guideline for High Blood Pressure

Paul K. Whelton and Robert M. Carey

JAMA | Viewpoint, November 20, 2017

The New 2017 ACC/AHA Guidelines “Up the Pressure” on Diagnosis and Treatment of Hypertension

Philip Greenland and Eric D. Peterson

JAMA | Editorial, November 20, 2017

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

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