“There has been a
carefully guarded secret in medicine: Evidence is often
inconclusive, and experts commonly disagree about what it means.”
inconclusive, and experts commonly disagree about what it means.”
The new guidelines says that people 60 years and older can seek a systolic blood pressure goal (the top number) of 150 or less. The old guidelines says that 140 or less should be the goal.
Before receiving alpha-blockers, beta-blockers, or any of
several miscellaneous agents, under the JNC 8 guidelines, patients would
receive a dosage adjustment and combinations of the 4 first-line therapies.
Triple therapy with an ACEI/ARB, CCB, and thiazide-type diuretic would precede
use of alpha-blockers, beta-blockers, or any of several other agents.
These new guidelines all but eliminate use of beta-blockers (including
nebivolol), alpha-blockers, loop diuretics, alpha1/beta-blockers, central
alpha2-adrenergic agonists, direct vasodilators, aldosterone antagonists, and
peripherally acting adrenergic antagonists in patients with newly diagnosed
hypertension. Caution is warranted in patients who are already stable on these
therapies.
The Final Reasons of JNC8 is as follows :
The Final Reasons of JNC8 is as follows :
1-The JNC 8 panel does not recommend first-line
therapy with beta-blockers and alpha-blockers due to 1 trial
that showed a higher rate of cardiovascular events with use of beta-blockers
compared with use of an ARB
2- and another trial in which alpha-blockers resulted in inferior cardiovascular outcomes compared with use of a diuretic.
3- In addition, a lack of evidence comparing the 4 first-line therapies with carvedilol, nebivolol, clonidine, hydralazine, reserpine, furosemide, spironolactone, and other similar medications precludes use of any medications other than ACEIs, ARBs, CCBs, and thiazide-type diuretics in the vast majority of patients.
One issue left secret in the world of evidence-based medicine; why they are preferring their very weak and not trusted evidence over expert opinion ,while
the “Expert Opinion” is the best evidenced for them in the absence of any evidence, otherwise .
2- and another trial in which alpha-blockers resulted in inferior cardiovascular outcomes compared with use of a diuretic.
3- In addition, a lack of evidence comparing the 4 first-line therapies with carvedilol, nebivolol, clonidine, hydralazine, reserpine, furosemide, spironolactone, and other similar medications precludes use of any medications other than ACEIs, ARBs, CCBs, and thiazide-type diuretics in the vast majority of patients.
One issue left secret in the world of evidence-based medicine; why they are preferring their very weak and not trusted evidence over expert opinion ,while
the “Expert Opinion” is the best evidenced for them in the absence of any evidence, otherwise .
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