Hypertension is a known cause of morbidity and mortality in Nigeria. It is a common, non - communicable disease that has been linked to other conditions like myocardial infarction, stroke, renal failure, and even death if not treated appropriately and in a timely fashion. In Nigeria, it has been estimated that at least 1 in 4 people have hypertension. A prevalence of about 28.9% was estimated as the percentage of the population that suffers from hypertension. This shows that hypertension is a condition that requires public health awareness as well as a structured treatment plan for a healthier population.

The Need for Proper Management of Hypertension

In consideration of the global burden of hypertension in various populations, there is a demand for a comprehensive management guideline that satisfies both the patient’s and clinician’s needs. Patients need to be assured of a reduction in elevated blood pressure whenever they adhere to the drugs and other principles of management. Clinicians require a validated, evidence-based guideline for the treatment of hypertension that is standardized and dynamic. These needs were met by the JNC report.

The Eighth Joint National Committee on Hypertension

The Joint National Committee on Hypertension (JNC) was appointed to provide reports that serve as guidelines for the detection, evaluation, treatment, and prevention of high blood pressure. The committee published its first report in 1976 with the 8^th report being the most recent one. 

Recommendations of the JNC

The recommendations made by the JNC are evidence-based and describe guidelines for treatment goals, selection of antihypertensive drugs as well strategies for starting and complementing antihypertensive drugs.

1. In the general population aged 60 years or older, antihypertensive drugs should be started to reduce a BP of 150/90 mmHg or higher to a much lower value. Recommendation – Grade A. Corollary Recommendation - In the general population aged 60 years or older, if pharmacological treatment for high BP results in lowering of the BP successfully, that is, to a value below 150/90mmHg and there are no adverse effects on the patient’s health, then the treatment shouldn’t be adjusted.
2. In the general population younger than 60 years, antihypertensive drugs should be started to reduce the diastolic blood pressure from 90mmHg or higher to a value less than 90mmHg. Hg. For ages 30 through 59 years, this is a Strong Recommendation – Grade A. For ages 18 through 29 years, it is an Expert’s Opinion – Grade E 
3. In the general population younger than 60 years, antihypertensive drugs should be started to reduce the systolic blood pressure of 140mmHg to a value lower than 140mmHg. This is based on a Grade E expert opinion.
4. In the population, aged 18 years or older with chronic kidney disease and a blood pressure value of 140/90mmHg or higher, antihypertensive drugs should be started to lower the BP to a value less than the above-stated. This is classified as an Expert Opinion – Grade E. This recommendation applies to people younger than 70 years of age with a Glomerular Filtration Rate (GFR) less than 60ml/min.
5. In the population aged 18 years or older with diabetes, antihypertensive drugs should be started to lower the BP to a value lower than 140/90mmHg, if the initial BP was 140/90mmHg or higher. This is an Expert Opinion – Grade E.
6. In the general nonblack population, including those with diabetes, the initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). Recommendation – Grade B.
7. In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. For the general black population, this is classified as a Moderate Recommendation – Grade B. For black patients with diabetes, it is classified as a Weak Recommendation – Grade C 
8. In the population, aged 18 years or older with Chronic Kidney Disease and hypertension, the initial or add-on antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. This is classified as a Moderate Recommendation – Grade B.
9. If the goal BP isn’t reached within a month of treatment, then the dosage of the initial drug could be increased or a second drug added from the drug classes in recommendation 6. The treatment regimen and the BP should be adjusted until the goal BP is reached. If it can’t be reached with 2 drugs, a third may be added. However, ACEI and ARB should not be used together for the same patient. if the drugs in Recommendation 6 cannot achieve the goal of BP, then drugs from other classes can be used. Ensure that a referral is made to a hypertension specialist if needed. This recommendation is classified as an Expert Opinion – Grade E 

Table Showing Different Recommendation Strengths

Conclusion

The JNC report for detecting, investigating, treating, and preventing hypertension is a relevant guideline for the management of hypertension and should be used as applicable in clinical settings.