Reconciling Systolic Blood Pressure Intervention Trial With Eighth Joint National Commission

A Nuanced View of Optimal Hypertension Control in the Chronic Kidney Disease Population

Ekamol Tantisattamo; Anum Hamiduzzaman; Peter Sohn; Rebecca Ahdoot; Ramy M. Hanna

Curr Opin Nephrol Hypertens. 2022;31(1):57-62.

European Society of Hypertension/European Society of Cardiology (ESH/ECC)

The 2018 European Society of Hypertension/European Society of Cardiology (ESH/ECC) guidelines define a prehypertension or low-risk hypertension group if BP is 130–139/85–89 mmHg.^[27] In this group, lifestyle modification is recommended unless there is a high incidence of CVD (mirroring AHA/ACC guidelines), there is no strong push for pharmacotherapy in this cohort.^[27]

The ESH/EC also defines a lower risk versus higher-risk stage I hypertension group >140mmHg where CV risk may be used to stratify the immediacy of pharmacotherapy.^[27] A higher risk BP group exists, analogous to JNC-8 stage II hypertension where pharmacotherapy is strongly recommended.^[27] Guidelines for use of mineralocorticoid receptor agonists and alpha₁ agonists are also suggested for resistant hypertension. The guidelines also define a higher acceptable hypertension threshold for patients > 65 years of age but <80 years of age and that goal is 140–159 mmHg, similar to the JNC-8 recommendations.^[27] The guidelines are nuanced and manage to weave together elements of JNC-8 and SPRINT data.

1 2 3 4 5 6 7 8 9 10

Next Section

Abstract and Introduction
Sprint Trial
Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients Trial
Eighth Joint National Commission
American College of Cardiology and the American Heart Association
European Society of Hypertension/European Society of Cardiology (ESH/ECC)
International Society of Hypertension
2021 Kidney Disease Improving Global Outcomes
Commentary: Future Directions in Chronic Kidney Disease Care
Conclusion
References
Sidebar

Table 1. Summarized blood pressure target from the landmark trials and different scientific societies
Study/Guideline	Blood pressure goals (mmHg)
SPRINT	SBP < 120
STEP	SBP < 110–130
JNC-8	Normal SBP < 120 Pre hypertension 120–139/DBP < 80 Stage I hypertension 140–159/< 90 Stage II hypertension 160/100Elderly patients BP < 150/90
ACC/AHA	Normal BP < 120 Prehypertension 121–129/< 80 Stage I hypertension 130–139/80–89 (lower than JNC-8) treatment decided by CVD risk Stage II hypertension >140/90 BP routine pharmacotherapy
ESH/ECC	Normal <130/80 Prehypertension group 130–139/85–89 Pharmacotherapy based on CVD risk Low-risk hypertension group >140–159/90 Can stratify to treat with pharmacotherapy by CVD risk High risk hypertension >160/90 always needs pharmacotherapy
ISH	Normal <140/90 Grade I hypertension 140–159/90–99 Grade II hypertension >159/99
KDIGO 2021	SBP goal <120, otherwise require treatment

ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; DBP, diastolic blood pressure; ESH/ECC, European Society of Hypertension/European College of Cardiology; ISH, International Society of Hypertension; JNC-8, Joint National Conference on Hypertension (eighth); KDIGO, Kidney Disease Improving Global Outcomes; SBP, systolic blood pressure; SPRINT, Systolic Blood Pressure Intervention; STEP, Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients.