JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).
The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.
Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.
The panelists disclosed they have relationships with a variety of pharmaceutical companies.