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JNC – 8 Jim Hoehns, Pharm.D.

Randomized controlled trials Adults ≥ 18 years old with hypertension N >100 Duration: ≥ 1 year Outcomes Mortality, CVD related-mortality,

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JNC – 8

Jim Hoehns, Pharm.D.

Evidence Review

Randomized controlled trials Adults ≥ 18 years old with hypertension N >100 Duration: ≥ 1 year Outcomes

Mortality, CVD related-mortality, CKD-related mortality MI, HF, hospitalization-HF Coronary or other revascularization ESRD▪ KF resulting in dialysis or transplantation, doubling of Cr value, halving of

GFR

3 Questions

In adults with HTN, Does initiating antihypertensive drug

therapy at specific BP thresholds improve health outcomes?

Does treatment with antihypertensive drug therapy to a specified goal lead to improvement in health outcomes?

Do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes?

Question 1

• 45 y.o. white female• Hx: HTN, hyperlipidemia, MDD• Meds: Atorvastatin 20mg QD, Fluoxetine 20mg QD• BP: 150/96, HR: 73Treatment:1. Lisinopril 10mg

QD2. Amlodipine 5mg3. HCTZ 12.5-25mg

QD4. Metoprolol BID

100 0 0 0

Question 2

•64 y.o. white male• Hx: CKD, HTN, hyperlipidemia• Meds: simvastatin 20mg QD, ASA 81mg QD, lisinopril 20mg QD• Labs: Cr = 1.9, K+ = 4.8, Est Clcr = 38 ml/min• BP: 152/94, HR: 68Treatment:1. HCTZ 12.5-25mg QD2. Amlodipine 5mg QD3. Losartan 50mg QD4. Increase lisinopril to

40mg QD 100 0 0 0

Question 3

•56 y.o. black male• Hx: diabetes, HTN, obstructive sleep apnea• Meds: metformin 1000mg BID, ASA 81mg QD, Gluctotrol XL 10mg QD• Labs: Cr = 1.0• BP: 148/88, HR: 70• Treatment:1. lisinopril 10mg QD2. losartan 50mg QD3. HCTZ 12.5-25mg QD4. Furosemide 20mg QD

100 0 0 0

Question 4

•67 y.o. white male•Hx: HTN, DM, hyperlipidemia, GERD, BPH•Meds: finasteride 5mg QD, Zocor 80mg QD, terazosin 10mg QD, glimepride 4mg QD, Actos 45mg QD, lisinopril 10mg QD, metformin XR 2000mg/d, ASA 81mg QD•Labs: Cr: 1.2, microalbumin 10mg/L, K+ = 4.3•BP: 160/88,HR: 57Treatment

1. HCTZ 12.5-25mg QD2. Hydralazine 25mg BID3. Diltiazem XR 180mg QD4. Increase lisinopril to

20mg QD 100 0 0 0

Question 5

•77 y.o. female•Hx: HTN, osteoporosis, angina, GERD•Meds: Reclast 5mg Qyear, Prilosec 40mg QD, Toprol XL 100mg QD, ASA, lisinopril/HCTZ 20/25mg QD•BP: 169/66, HR: 57, weight: 100 lbs, Cr = 0.3, K+ = 4.2Treatment:

1. Terazosin 2. Amlodipine 3. Hydralazine4. Furosemide

100 0 0 0

Question 6

•78 y.o. female•Hx: Afib (c/o palpitations), HTN•Meds: warfarin, metoprolol 100mg BID, losartan 50mg QD•BP: 154/82 HR: 90Treatment1. Amlodipine 2. Diltiazem XR 3. Spironolactone4. Furosemide

100 0 0 0

Question 7

•66 y.o. black male• Hx: HTN, s/p MI 2 months ago, hyperlipidemia• Meds: atorvastatin 20mg QD, ASA 81mg QD, Plavix 75mg QD, HCTZ 25mg QD, metoprolol 100mg BID• BP: 152/92, HR: 62Treatment1. Amlodipine2. Lisinopril3. Diltiazem XR4. Furosemide 100 0 0 0

Question 8

•66 y.o. male•Hx: CKD, HTN, diabetes, PAD, hypothyroidism, hyperlipidemia•Meds: ASA 81mg QD, Lantus + Humalog, levothyroxine 0.1mg QD, Crestor 20mg QD, lisinopril 20mg QD•Labs: Cr = 2.8, K+ = 4.8•BP: 150/92, HR: 68Treatment1. atenolol2. amlodipine3. HCTZ4. hydralazine

100 0 0 0

Question 9

•70 y.o. male •Hx: HTN, LVH, GERD, TIA•Meds: Plavix 75mg QD, famotidine 20mg QD, HCTZ 25mg QD•BP: 154/86, HR: 70Treatment1. Metoprolol2. Lisinopril3. Amlodipine4. Spironolactone

100 0 0 0

Question 10

•62 y.o. female•Hx: COPD, HTN, OA, obesity, CAD, occ symptomatic angina•Meds: Spiriva, Advair, ASA, Imdur 90mg QD, lisinopril 40mg QD, metoprolol XL 100mg QD, Nitrostat PRN•BP: 152/90, HR: 64 Treatment

1. HCTZ2. valsartan3. amlodipine4. terazosin

100 0 0 0

Summary

Age ≥ 60: goal BP is <150/90 Age <60: goal BP is <140/90 First line therapies

Thiazide, CCB’s, ACEI, ARB Thiazide or CCB recommended over

ACEI in blacks with diabetes Beta-blockers: not recommended as

first line therapy