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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
National Heart, Lung, and Blood Institute National High Blood Pressure Seventh Report of the Education Program Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) EXPRESS
CVD Risk
HTN prevalence ~ 50 million people in the United States. The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors. Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg. Prehypertension signals the need for increased education to reduce BP in order to prevent hypertension.
Benefits of Lowering BP
Average Percent Reduction Stroke incidence Myocardial infarction Heart failure 3540% 2025% 50%
Benefits of Lowering BP
In stage 1 HTN and additional CVD risk factors, achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated.
BP Control Rates
Trends in awareness, treatment, and control of high blood pressure in adults ages 1874
National Health and Nutrition Examination Survey, Percent II II II (Phase 1) (Phase 2) 197680 198891 199194 Awarenes s Treatmen t Control 51 31 10 73 55 29 68 54 27
1999 2000 70 59 34
rces: Unpublished data for 19992000 computed by M. Wolz, National Heart, Lung, and Blood Institute; JNC 6.
BP Measurement Techniques
Method In-office Brief Description Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm. Indicated for evaluation of whitecoat HTN. Absence of 1020% BP decrease during sleep may indicate increased CVD risk. Provides information on response to therapy. May help improve adherence to therapy and
Ambulatory BP monitoring
Self-measurement
Laboratory Tests
Routine Tests Electrocardiogram Urinalysis Blood glucose, and hematocrit Serum potassium, creatinine, or the corresponding estimated GFR, and calcium Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides Optional tests Measurement of urinary albumin excretion or albumin/creatinine ratio More extensive testing for identifiable causes is not
Treatment Overview
Goals of therapy Lifestyle modification Pharmacologic treatment Algorithm for treatment of hypertension Classification and management of BP for adults Followup and monitoring
Goals of Therapy
Reduce CVD and renal morbidity and mortality. Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease. Achieve SBP goal especially in persons >50 years of age.
Lifestyle Modification
Modification Weight reduction Adopt DASH eating plan Dietary sodium reduction Physical activity Moderation of alcohol consumption Approximate SBP reduction (range) 520mmHg/10 kg weight loss 814 mmHg 28 mmHg 49 mmHg 24 mmHg
Stage 1 Hypertension
(SBP 140159 or DBP 9099 mmHg) Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination.
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg) 2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB)
Not at Goal Blood Pressure Optimize dosages or add additional drugs until goal blood pressure is achieved. Consider consultation with hypertension specialist.
Drug(s) for the compelling indications. Other antihypertensive Stage 2 >160 or Yes Two-drug combination drugs (diuretics, *Treatment determined by highest Hypertensio therapy should beBP category. in those at risk for orthostatic hypotension. ACEI, ARB, BB, >100 cautiously for most (usually Initial combined used n Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg. thiazide-type diuretic CCB) as needed. and ACEI or ARB or BB
Yes
NICE GUIDELINES
Special Considerations
Compelling Indications Other Special Situations Minority populations Obesity and the metabolic syndrome Left ventricular hypertrophy Peripheral arterial disease Hypertension in older persons Postural hypotension Dementia Hypertension in women Hypertension in children and adolescents
Postmyocardial infarction
Failure Guideline, MERIT-HF, COPERNICUS, CIBIS, SOLVD, BB, ACEI, ALDO ANT AIRE, TRACE, ValHEFT, RALES ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS ALLHAT, HOPE,
THIAZ, ACEI
Population-Based Strategy
SBP Distributions After Intervention Before Intervention