Use of ACE inhibitors and ARBs is recommended in all patients with CKD regardless of ethnic background, either as first-line therapy or in addition to first-line therapy.When initiating therapy, patients of African descent without CKD should use CCBs and thiazides instead of ACE inhibitors.Several medications are now designated as later-line alternatives, including the following: beta-blockers, alphablockers, alpha1/beta-blockers (eg, carvedilo), vasodilating beta-blockers (eg, nebivolol), central alpha2/-adrenergic agonists (eg, clonidine), direct vasodilators (eg, hydralazine), loop diruretics (eg, furosemide), aldosterone antagoinsts (eg, spironolactone), and peripherally acting adrenergic antagonists (eg, reserpine).
Second- and third-line alternatives included higher doses or combinations of ACE inhibitors, ARBs, thiazide-type diuretics, and CCBs.First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs.In patients 18 to 59 years of age without major comorbidities, and in patients 60 years or older who have diabetes, chronic kidney disease (CKD), or both conditions, the new goal blood pressure level is In patients 60 years or older who do not have diabetes or chronic kidney disease, the goal blood pressure level is now Important changes from the JNC 7 guidelines 2 include the following: The new guidelines also introduce new recommendations designed to promote safer use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). The new guidelines emphasize control of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with age- and comorbidity-specific treatment cutoffs. Patients will be asking about the new JNC 8 hypertension guidelines, which were published in the Journal of the American Medical Association on December 18, 2013. Compared with previous hypertension treatment guidelines, the Joint National Committee (JNC 8) guidelines advise higher blood pressure goals and less use of several types of antihypertensive medications.
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