1988 Joint National Committee guidelines for managing hypertension: how are they different?
Ray W. Gifford, MDAddress reprint requests to R.W.G., Department of Hypertension and Nephrology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
The new Joint National Committee guidelines on managing hypertension retain the stepped care concept but add flexibility. The 1988 report recommends that, in addition to diuretics and beta blockers, calcium-channel blockers and ACE inhibitors be considered for initial monotherapy. Compared to previous JNC reports, lower starting doses of most antihypertensive drugs, especially diuretics, are recommended. For the first time, the guidelines discuss the cost of antihypertensive therapy. Specific nonpharmacologic therapy and its role in relation to drug therapy are discussed in greater detail than previous reports.