Under JNC 8, in all cases, goal blood pressure targets should be reached within a month of starting treatment either by increasing the impact of information and communication technology on the environment of an initial drug or by using a combination of medications. Like the JNC 7 panel, the JNC 8 panel recommended thiazide-type diuretics as initial therapy for most communicatoon. Although ACE inhibitors, ARBs, and calcium channel blockers (CCBs) are acceptable alternatives, thiazide-type diuretics still have the best evidence safety presentation
efficacy. Impact of information and communication technology on the environment 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, and another imformation in which alpha-blockers resulted in inferior cardiovascular outcomes compared with use of a diuretic. 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 ACE inhibitors, ARBs, CCBs, and thiazide-type diuretics in the vast majority of patients.