NephMadness 2014: In defense of JNC8

Nephrology Madness 2014See the current standings! | for backstory | #NephMadness on Twitter


Susan Steigerwalt, M.D. FACP

Dr. Susan P. Steigerwalt, MD, is the director of the hypertension clinic at St Clair Specialty Physicians and a member of the division of nephrology and hypertension at St John Hospital in Detroit, Michigan. She is also a clinical associate professor at Wayne State University. Her formal certifications are in internal medicine (ABIM), nephrology (ABIM) and Hypertension (ASH). Her particular research interests include the use of cognitive behavioral interventions to improve adherence in hypertensive women, resistant hypertension, primary aldosteronism and role of aldosterone in progression of kidney disease. She is delighted to be a St John site Principal Investigator for CRIC.


JNC-8 is a carefully crafted, conservative document which answers three very specific questions using RCT data and carefully rating the available evidence. It is far narrower in scope than JNC-7 and it is not a “how to” document. JNC-8 tells us what we do not have evidence for; what we do not know; and what we really need to know: ie, clear data on systolic BP goals. (I await SPRINT). A clear division within the JNC working group regarding goal BP age 60-80 was published March 15 in the Annals of Internal Medicine (PDF). This minority report looks at the evidence for those age 60-80 and concludes the goal systolic should be 140, NOT 150 as stated in the majority position

My choice for usable guidelines for the real world are the ASH-ISH guidelines and the AHA-CDC-ACC guidelines on systems approach to blood pressure control. Both are short, succinct and available on line, free of charge.

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