JNC 7 or JNC 8: Which Should I Use?

I gave a CME seminar this week on treating hypertension in the elderly and after my presentation a clinical pharmacist asked me an interesting question: “What do you follow? JNC 7 or JNC 8?”.


I thought this was an interesting question and one I hadn’t thought about at all. After all shouldn’t an updated guideline trump the previous one? I like JNC 8 because its methodology is more explicit and consistent with IOM principles than JNC 7. One can argue with some of the decisions made about the evidence review (ie that they only included RCTs and ignored systematic reviews and observational data) and be concerned about the degree of conflicts of interest of the panel members. But what JCN 8 did was make life simpler in that the BP goals are easily remembered: <150/90 for those over 60 yrs of age and < 140/90 for everyone else including those with diabetes or CKD (regardless of age). So for these reasons I prefer JNC 8. Is it perfect? No but I suspect they will address many of the concerns critics have expressed and further questions that need to be addressed in future updates (that they promise will come in a timely fashion).