Guidelines and Resources

Click here for a printer friendly version. | Click here for important safety information.

In 2003, the American Heart Association published The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). The JNC 7 is the latest of a series of reports designed to provide an evidence-based approach to hypertension prevention and management. The JNC 7 is based on newer hypertension studies and trials and was developed to clarify the guidelines and simplify the classification of blood pressure in order to make it easier for clinicians to use.¹ A JNC 7 Express was developed for busy physicians.¹ Among the key messages from the report:

• In persons older than 50 years, systolic blood pressure greater than 140 mmHg is a much more important cardiovascular disease (CVD) risk factor than diastolic blood pressure.¹
• The risk of CVD beginning at 115/75 mmHg doubles with each increment of 20/10 mmHg; individuals who are normotensive at age 55 have a 90 percent lifetime risk for developing hypertension.¹
• Individuals with a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD.¹
• Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers).¹
• Most patients with hypertension will require two or more antihypertensive medications to achieve goal blood pressure (<140/90 mmHg, or <130/80 mmHg for patients with diabetes or chronic kidney disease).¹
• If blood pressure is >20/10 mmHg above goal blood pressure, consideration should be given to initiating therapy with two agents, one of which usually should be a thiazide-type diuretic.¹
• The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with, and trust in, the clinician. Empathy builds trust and is a potent motivator.¹
• In presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.¹

The Guidelines recommend the use of calcium channel blockers as an initial drug choice, after lifestyle modification, in Stage 1 and Stage 2 Hypertension in patients without compelling indications and as needed in patients with diabetes and those at high risk for CVD.²

The National Institutes of Health, Department of Health and Human Services have three versions of the JNC 7: an express card for easy reference, a copy of the full report, and a PubMed Abstract; as well additional information for health professionals (the 4th report on High Blood Pressure in Children and Adolescents, a JNC 7 Application for Palm OS and Pocket PC, a Physician Reference Card and several slide shows) available online at www.nhlbi.nih.gov/guidelines/hypertension/.

A Free Online CME for Hypertension from The Cleveland Clinic Foundation Center for Continuing Education, accredited by the Accreditation Council for Continuing Medical Education, is available online at www.clevelandclinicmeded.com/decisionmaking/hypertension2/intro1.asp-15k

References

1. JNC 7 Express: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. U.S. Department of Health and Human Services. PDF. Accessed online 6/13/07. www.daxor.com/articles/Hypertension%20Guidelines.pdf
2. Reference Card from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). PDF Retrieved 3/18/07 at 4:07 PM from www.nhlbi.nih.gov/guidelines/hypertension/