Hypertension Management. Part 1
In just five months’ time, the Executive Committee and writing teams for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) produced the succinct JNC 7 Express,* with a more comprehensive version to appear later.
Previous JNC reports, says Claude Lenfant, MD, Director of the National Heart, Lung, and Blood Institute (NHLBI), have not been used to their greatest potential. The current report, which incorporates data from numerous observational studies and clinical trials, simplifies blood pressure classifications and offers health care providers a clear, concise guideline for the prevention and treatment of hypertension.
The abbreviated report was completed and released rapidly “because of the urgency of applying the new information,” writes Dr. Lenfant in the report’s preface.
Reclassification of Blood Pressure
For adults 18 and older, the JNC 7 redefines “normal” blood pressure (BP) as below 120/80 mm Hg and combines JNC 6′s classifications of stages 2 and 3 hypertension into the current stage 2 (TABLE 1). Between normal and stage 1 hypertension, a new category termed prehypertension has been added. Prehypertensive patients are at increased risk for progression to hypertension — and at double the risk, compared with normotensive patients, if their values are in the range of 130/80 to 139/89 mm Hg.
| Table 1 Classification and Management of Blood Pressure for Adults* | |||||
| Initial Drug Therapy | |||||
| BP classification | SBP* (mm Hg) | DBP* (mm Hg) | Lifestyle modification | Without compelling indications | With compelling indications (see table 2) |
| Normal | < 120 | and < 80 | Encourage | No antihypertensive drug indicated | Drug(s) for compelling indications |
| Prehypertension | 120 139 | or 80 89 | Yes | ||
| Stage 1 hypertension | 140 159 | or 90 99 | Yes | Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination | Drug(s) for the compelling indications.Other antihypertensive drugs diuretics (ACEI, ARB, BB, CCB), as needed |
| Stage 2 hypertension | Greater than or equal to 160 | Or greater than or equal to 100 | Yes | Two-drug combination or most(usually thiazide-type diuretic and ACEI or ARB or BB or CCB) | |
| BP, blood pressure; SBP, systolic BP; DBP, diastolic BP; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, b-blocker; CCB, calcium channel blocker. * Treatment determined by highest BP category. Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mm Hg. Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension. | |||||
* This article is based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 Express). NIH Publication No. 03-5233. Most of the remaining references are cited in the report.
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