U.S.

Department of
HeaIth and Human
Services
NationaI Institutes
of HeaIth
NationaI Heart, Lung,
and BIood Institute
The Seventh Report of the
Joint NationaI Committee on
Prevention, Detection,
EvaIuation, and Treatment of
High BIood Pressure (JNC 7)
The Seventh Report of the
Joint NationaI Committee on
Prevention, Detection,
EvaIuation, and Treatment of
High BIood Pressure (JNC 7)
NationaI Heart, Lung, and BIood Institute
NationaI High BIood Pressure Education Program
NationaI Heart, Lung, and BIood Institute
NationaI High BIood Pressure Education Program
8eventh Report of the
Jo|nt Nat|ona| 6omm|ttee on
Prevent|on, 0etect|on,
Eva|uat|on, and
Treatment of h|gh
|ood Pressure
(JN6 7} !#$$
Nat|ona| heart, Lung, and
|ood |nst|tute
Nat|ona| h|gh |ood Pressure
Educat|on Program
8eventh Jo|nt Nat|ona| 6omm|ttee
on Prevent|on, 0etect|on, Eva|uat|on,
and Treatment of h|gh |ood Pressure
0eorge L. 8a|r|s, V.0.
0eparlrerl ol Preverl|ve Ved|c|re
Rusr-Presoyler|ar-3l. Lu|e's Ved|ca| Cerler
lerry R. 8|ac|, V.0.
0eparlrerl ol Preverl|ve Ved|c|re
Rusr-Presoyler|ar-3l. Lu|e's Ved|ca| Cerler
w||||ar C. Cusrrar, V.0.
Preverl|ve Ved|c|re 3ecl|or
velerars Alla|rs Ved|ca| Cerler
Lee A. 0reer, V.0.
0eparlrerl ol Far||y Ved|c|re
ur|vers|ly ol V|cr|gar
Josepr L. lzzo, Jr., V.0.
0eparlrerl ol Ved|c|re ard Prarraco|ogy
3uNY al 8ulla|o 3croo| ol Ved|c|re
0ar|e| w. Jores, V.0.
0eparlrerl ol Ved|c|re ard Cerler lor Exce||erce
|r Card|ovascu|ar-Rera| Researcr
ur|vers|ly ol V|ss|ss|pp| Ved|ca| Cerler
8arry J. Valersor, V.0.
0eparlrerl ol Ved|c|re
ur|vers|ly ol V|ar| 3croo| ol Ved|c|re
3uzarre 0par||, V.0.
0eparlrerl ol Ved|c|re, Prys|o|ogy & 8|oprys|cs
0|v|s|or ol Card|ovascu|ar 0|sease
ur|vers|ly ol A|aoara
Jac|sor T. wr|grl, Jr., V.0.
ur|vers|ly losp|la|s ol C|eve|ard
Case weslerr Reserve ur|vers|ly
Execul|ve 3ecrelary
EdWard J. Rocce||a, Pr.0, V.P.l.
Nal|ora| learl, Lurg, ard 8|ood lrsl|lule
Execut|ve 6omm|ttee
Arar Crooar|ar, V.0., Cra|r
0ear's 0ll|ce ard 0eparlrerl ol Ved|c|re
8oslor ur|vers|ly 3croo| ol Ved|c|re
Nat|ona| h|gh |ood Pressure
Educat|on Program
6oord|nat|ng 6omm|ttee
Arer|car Acadery ol Far||y Prys|c|ars
Arer|car Acadery ol Neuro|ogy
Arer|car Acadery ol 0prlra|ro|ogy
Arer|car Acadery ol Prys|c|ar Ass|slarls
Arer|car Assoc|al|or ol 0ccupal|ora| lea|lr Nurses
Arer|car Co||ege ol Card|o|ogy
Arer|car Co||ege ol Cresl Prys|c|ars
Arer|car Co||ege ol 0ccupal|ora| ard Erv|rorrerla| Ved|c|re
Arer|car Co||ege ol Prys|c|ars
Arer|car 3oc|ely ol lrlerra| Ved|c|re
Arer|car Co||ege ol Preverl|ve Ved|c|re
Arer|car 0erla| Assoc|al|or
Arer|car 0|aoeles Assoc|al|or
Arer|car 0|elel|c Assoc|al|or
Arer|car learl Assoc|al|or
Arer|car losp|la| Assoc|al|or
Arer|car Ved|ca| Assoc|al|or
Arer|car Nurses Assoc|al|or
Arer|car 0plorelr|c Assoc|al|or
Arer|car 0sleopalr|c Assoc|al|or
Arer|car Prarraceul|ca| Assoc|al|or
Arer|car Pod|alr|c Ved|ca| Assoc|al|or
Arer|car Puo||c lea|lr Assoc|al|or
Arer|car Red Cross
Arer|car 3oc|ely ol lea|lr-3ysler Prarrac|sls
Arer|car 3oc|ely ol lyperlers|or
Arer|car 3oc|ely ol Neprro|ogy
Assoc|al|or ol 8|ac| Card|o|og|sls
C|l|zers lor Puo||c Acl|or or l|gr 8|ood Pressure ard Cro|eslero|, lrc.
lyperlers|or Educal|or Fourdal|or, lrc.
lrlerral|ora| 3oc|ely or lyperlers|or |r 8|ac|s
Nal|ora| 8|ac| Nurses Assoc|al|or, lrc.
Nal|ora| lyperlers|or Assoc|al|or, lrc.
Nal|ora| K|drey Fourdal|or, lrc.
Nal|ora| Ved|ca| Assoc|al|or
Nal|ora| 0plorelr|c Assoc|al|or
Nal|ora| 3lro|e Assoc|al|or
NlL8l Ad loc Corr|llee or V|ror|ly Popu|al|ors
3oc|ely lor Nulr|l|or Educal|or
Tre 3oc|ely ol 0er|alr|c Card|o|ogy
Federa| Agenc|es:
Agercy lor lea|lrcare Researcr ard 0ua||ly
Cerlers lor Ved|care & Ved|ca|d 3erv|ces
0eparlrerl ol velerars Alla|rs
lea|lr Resources ard 3erv|ces Adr|r|slral|or
Nal|ora| Cerler lor lea|lr 3lal|sl|cs
Nal|ora| learl, Lurg, ard 8|ood lrsl|lule
Nal|ora| lrsl|lule ol 0|aoeles ard 0|gesl|ve ard K|drey 0|seases
JN6 7
Express3ucc|rcl ev|derce-oased
recorrerdal|ors. Puo||sred |r
Vay 21, 2003, ard as a
0overrrerl Pr|rl|rg 0ll|ce
puo||cal|or.
Fu|| Reporlcorprerers|ve
jusl|l|cal|or ard ral|ora|e (cor|rg
soor).
Purpose
why JN6 7?
Puo||cal|or ol rary reW slud|es.
Need lor a reW, c|ear, ard corc|se gu|de||re uselu| lor
c||r|c|ars.
Need lo s|rp||ly lre c|ass|l|cal|or ol 8P.
For persors over age 50, 38P |s a rore |rporlarl lrar 08P as Cv0 r|s|
laclor.
3larl|rg al 115/Z5 rrlg, Cv0 r|s| douo|es W|lr eacr |rcrererl ol
20/10 rrlg lrrougroul lre 8P rarge.
Persors Wro are rorrolers|ve al age 55 rave a 90 ||lel|re r|s| lor
deve|op|rg lTN.
Trose W|lr 38P 120-139 rrlg or 08P 80-89 rrlg srou|d oe
cors|dered preryperlers|ve Wro requ|re rea|lr-prorol|rg ||lesly|e
rod|l|cal|ors lo preverl Cv0.
New Features and Key Hessages
New Features and Key Hessages
(6ont|nued}
Tr|az|de-lype d|urel|cs srou|d oe |r|l|a| drug lrerapy lor rosl, e|lrer
a|ore or coro|red W|lr olrer drug c|asses.
Cerla|r r|gr-r|s| cord|l|ors are corpe|||rg |rd|cal|ors lor olrer drug
c|asses.
Vosl pal|erls W||| requ|re lWo or rore arl|ryperlers|ve drugs lo
acr|eve goa| 8P.
ll 8P |s >20/10 rrlg aoove goa|, |r|l|ale lrerapy W|lr lWo agerls,
ore usua||y srou|d oe a lr|az|de-lype d|urel|c.
New Features and Key Hessages
(6ont|nued}
Tre rosl ellecl|ve lrerapy prescr|oed oy lre carelu| c||r|c|ar W||| corlro|
lTN or|y |l pal|erls are rol|valed.
Vol|val|or |rproves Wrer pal|erls rave pos|l|ve exper|erces W|lr, ard
lrusl |r, lre c||r|c|ar.
Erpalry ou||ds lrusl ard |s a polerl rol|valor.
Tre respors|o|e prys|c|ar's judgrerl rera|rs pararourl.
P Heasurement and
6||n|ca| Eva|uat|on
C|ass|l|cal|or ol 8P
Cv0 R|s|
8erel|ls ol LoWer|rg 8P
8P Corlro| Rales
8P Veasurererl Tecrr|ques
lr-oll|ce
Arou|alory 8P Vor|lor|rg
3e|l-reasurererl
Pal|erl Eva|ual|or
Laooralory Tesls ard 0lrer 0|agrosl|c Procedures
|ood Pressure 6|ass|f|cat|on
Norra| <120 ard <80
Preryperlers|or 120-139 or 80-89
3lage 1 lyperlers|or 110-159 or 90-99
3lage 2 lyperlers|or >10 or >100
P 6|ass|f|cat|on 8P mmhg 0P mmhg
6V0 R|sk
lTN preva|erce ~ 50 r||||or peop|e |r lre ur|led 3lales.
Tre 8P re|al|orsr|p lo r|s| ol Cv0 |s corl|ruous, cors|slerl, ard
|rdeperderl ol olrer r|s| laclors.
Eacr |rcrererl ol 20/10 rrlg douo|es lre r|s| ol Cv0 across lre
erl|re 8P rarge slarl|rg lror 115/Z5 rrlg.
Preryperlers|or s|gra|s lre reed lor |rcreased educal|or lo reduce
8P |r order lo preverl ryperlers|or.
enef|ts of Lower|ng P
Average Percent Reduct|on
3lro|e |rc|derce 35-10
Vyocard|a| |rlarcl|or 20-25
learl la||ure 50
enef|ts of Lower|ng P
lr slage 1 lTN ard add|l|ora| Cv0 r|s| laclors, acr|ev|rg
a susla|red 12 rrlg reducl|or |r 38P over 10 years W|||
preverl 1 dealr lor every 11 pal|erls lrealed.
P 6ontro| Rates
Trerds |r aWareress, lrealrerl, ard corlro| ol r|gr
o|ood pressure |r adu|ls ages 18-Z1
Nat|ona| hea|th and Nutr|t|on Exam|nat|on 8urvey, Percent
||
197-80
||
(Phase 1}
1988-91
||
(Phase 2}
1991-94 1999-2000
Awareness 51 Z3 8 Z0
Treatment 31 55 51 59
6ontro| 10 29 2Z 31
3ources: urpuo||sred dala lor 1999-2000 corpuled oy V. wo|z, Nal|ora| learl, Lurg, ard 8|ood lrsl|lule; JNC .
P Heasurement Techn|ques
Hethod r|ef 0escr|pt|on
lr-oll|ce TWo read|rgs, 5 r|rules aparl, s|ll|rg |r
cra|r. Corl|rr e|evaled read|rg |r
corlra|alera| arr.
Arou|alory 8P ror|lor|rg lrd|caled lor eva|ual|or ol 'Wr|le-coal lTN.
Aoserce ol 10-20 8P decrease dur|rg
s|eep ray |rd|cale |rcreased Cv0 r|s|.
3e|l-reasurererl Prov|des |rlorral|or or resporse lo lrerapy.
Vay re|p |rprove adrererce lo lrerapy ard
eva|uale 'Wr|le-coal lTN.
ff|ce P Heasurement
use auscu|lalory relrod W|lr a proper|y ca||oraled ard va||daled
|rslrurerl.
Pal|erl srou|d oe sealed qu|el|y lor 5 r|rules |r a cra|r
(rol or ar exar lao|e), leel or lre l|oor, ard arr supporled al rearl
|eve|.
Appropr|ale-s|zed cull srou|d oe used lo ersure accuracy.
Al |easl lWo reasurererls srou|d oe rade.
C||r|c|ars srou|d prov|de lo pal|erls, veroa||y ard |r Wr|l|rg, spec|l|c 8P
ruroers ard 8P goa|s.
Ambu|atory P Hon|tor|ng
A8PV |s Warrarled lor eva|ual|or ol 'Wr|le-coal lTN |r lre aoserce ol
largel orgar |rjury.
Arou|alory 8P va|ues are usua||y |oWer lrar c||r|c read|rgs.
AWa|e, |rd|v|dua|s W|lr ryperlers|or rave ar average 8P ol >135/85
rrlg ard dur|rg s|eep >120/Z5 rrlg.
8P drops oy 10 lo 20 dur|rg lre r|grl; |l rol, s|gra|s poss|o|e
|rcreased r|s| lor card|ovascu|ar everls.
8e|f-Heasurement of P
Prov|des |rlorral|or or:
1. Resporse lo arl|ryperlers|ve lrerapy
2. lrprov|rg adrererce W|lr lrerapy
3. Eva|ual|rg Wr|le-coal lTN
lore reasurererl ol >135/85 rrlg |s gerera||y cors|dered lo oe
ryperlers|ve.
lore reasurererl dev|ces srou|d oe crec|ed regu|ar|y.
Pat|ent Eva|uat|on
Eva|ual|or ol pal|erls W|lr docurerled lTN ras lrree oojecl|ves:
1. Assess ||lesly|e ard |derl|ly olrer Cv r|s| laclors or corcor|larl
d|sorders lral allecls progros|s ard gu|des lrealrerl.
2. Revea| |derl|l|ao|e causes ol r|gr 8P.
3. Assess lre preserce or aoserce ol largel orgar darage ard Cv0.
6V0 R|sk Factors
lyperlers|or
C|garelle sro||rg
0oes|ly (8Vl >30 |g/r
2
)
Prys|ca| |racl|v|ly
0ys||p|der|a
0|aoeles re|||lus
V|croa|our|rur|a or esl|raled 0FR <0 r|/r|r
Age (o|der lrar 55 lor rer, 5 lor Worer)
Far||y r|slory ol preralure Cv0
(rer urder age 55 or Worer urder age 5)
Corporerls ol lre relaoo||c syrdrore.
|dent|f|ab|e
6auses of hypertens|on
3|eep aprea
0rug-|rduced or re|aled causes
Crror|c ||drey d|sease
Pr|rary a|dosleror|sr
Rerovascu|ar d|sease
Crror|c slero|d lrerapy ard Cusr|rg's syrdrore
Preocrrorocylora
Coarclal|or ol lre aorla
Tryro|d or paralryro|d d|sease
Target rgan 0amage
learl
Lell verlr|cu|ar ryperlropry
Arg|ra or pr|or ryocard|a| |rlarcl|or
Pr|or cororary revascu|ar|zal|or
learl la||ure
8ra|r
3lro|e or lrars|erl |screr|c allac|
Crror|c ||drey d|sease
Per|prera| arler|a| d|sease
Rel|ropalry
Laboratory Tests
Roul|re Tesls
E|eclrocard|ograr
ur|ra|ys|s
8|ood g|ucose, ard reralocr|l
3erur polass|ur, creal|r|re, or lre correspord|rg esl|raled 0FR,
ard ca|c|ur
L|p|d prol||e, aller 9- lo 12-rour lasl, lral |rc|udes r|gr-ders|ly ard
|oW-ders|ly ||poprole|r cro|eslero|, ard lr|g|ycer|des
0pl|ora| lesls
Veasurererl ol ur|rary a|our|r excrel|or or a|our|r/creal|r|re ral|o
Vore exlers|ve lesl|rg lor |derl|l|ao|e causes |s rol gerera||y |rd|caled
ur|ess 8P corlro| |s rol acr|eved
Treatment
verv|ew
0oa|s ol lrerapy
L|lesly|e rod|l|cal|or
Prarraco|og|c lrealrerl
A|gor|lrr lor lrealrerl ol ryperlers|or
C|ass|l|cal|or ard raragererl ol 8P lor adu|ls
Fo||oWup ard ror|lor|rg
oa|s of Therapy
Reduce Cv0 ard rera| roro|d|ly ard rorla||ly.
Treal lo 8P <110/90 rrlg or 8P <130/80 rrlg |r pal|erls
W|lr d|aoeles or crror|c ||drey d|sease.
Acr|eve 38P goa| espec|a||y |r persors >50 years ol age
L|festy|e Hod|f|cat|on
Hod|f|cat|on Approx|mate 8P reduct|on
(range}
we|grl reducl|or 5-20 rrlg/10 |g We|grl |oss
Adopl 0A3l eal|rg p|ar 8-11 rrlg
0|elary sod|ur reducl|or 2-8 rrlg
Prys|ca| acl|v|ly 1-9 rrlg
Voderal|or ol a|coro|
corsurpl|or
2-1 rrlg
A|gor|thm for Treatment of hypertens|on
Not at GoaI BIood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
InitiaI Drug Choices
Drug(s) for the compeIIing
indications
Other antihypertensive drugs
(diuretics, ACE, ARB, BB, CCB)
as needed.
ith CompeIIing
Indications
LifestyIe Modifications
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg)
2-drug combination for most (usually
thiazide-type diuretic and
ACE, or ARB, or BB, or CCB)
Stage 1 Hypertension
(SBP 140159 or DBP 9099 mmHg)
Thiazide-type diuretics for most.
May consider ACE, ARB, BB, CCB,
or combination.
ithout CompeIIing
Indications
Not at GoaI
BIood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
6|ass|f|cat|on and Hanagement
of P for adu|ts
P
c|ass|f|cat|on
8P*
mmhg
0P*
mmhg
L|festy|e
mod|f|cat|on
|n|t|a| drug therapy
w|thout compe|||ng
|nd|cat|on
w|th compe|||ng
|nd|cat|ons
Norra| <120 ard <80 Ercourage
Preryperlers|or 120-139 or 80-89 Yes No arl|ryperlers|ve drug
|rd|caled.
0rug(s) lor corpe|||rg
|rd|cal|ors.
t
3lage 1
lyperlers|or
110-159 or 90-99 Yes Tr|az|de-lype d|urel|cs lor
rosl. Vay cors|der ACEl,
AR8, 88, CC8, or
coro|ral|or.
0rug(s) lor lre
corpe|||rg
|rd|cal|ors.
t
0lrer arl|ryperlers|ve
drugs (d|urel|cs, ACEl,
AR8, 88, CC8) as
reeded.
3lage 2
lyperlers|or
>10 or >100 Yes TWo-drug coro|ral|or lor
rosl
f
(usua||y lr|az|de-lype
d|urel|c ard ACEl or AR8 or
88 or CC8).
Treatment determined by highest BP category.
|
nitial combined therapy should be used cautiously in those at risk for orthostatic hypotension.

Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg.
Fo||owup and Hon|tor|ng
Pal|erls srou|d relurr lor lo||oWup ard adjuslrerl ol red|cal|ors
url|| lre 8P goa| |s reacred.
Vore lrequerl v|s|ls lor slage 2 lTN or W|lr corp||cal|rg cororo|d
cord|l|ors.
3erur polass|ur ard creal|r|re ror|lored 1-2 l|res per year.
Fo||owup and Hon|tor|ng
(cont|nued}
Aller 8P al goa| ard slao|e, lo||oWup v|s|ls al 3- lo -rorlr |rlerva|s.
Cororo|d|l|es, sucr as rearl la||ure, assoc|aled d|seases, sucr as
d|aoeles, ard lre reed lor |aooralory lesls |rl|uerce lre lrequercy
ol v|s|ls.
8pec|a| 6ons|derat|ons
Corpe|||rg lrd|cal|ors
0lrer 3pec|a| 3|lual|ors
V|ror|ly popu|al|ors
0oes|ly ard lre relaoo||c syrdrore
Lell verlr|cu|ar ryperlropry
Per|prera| arler|a| d|sease
lyperlers|or |r o|der persors
Poslura| rypolers|or
0ererl|a
lyperlers|or |r Worer
lyperlers|or |r cr||drer ard ado|escerls
lyperlers|or urgerc|es ard erergerc|es
6ompe|||ng |nd|cat|ons for
|nd|v|dua| 0rug 6|asses
6ompe|||ng |nd|cat|on |n|t|a| Therapy pt|ons 6||n|ca| Tr|a| as|s
ACC/AlA learl Fa||ure
0u|de||re, VERlT-lF,
C0PERNlCu3, Cl8l3,
30Lv0, AlRE, TRACE,
va|lEFT, RALE3
ACC/AlA Posl-Vl
0u|de||re, 8lAT,
3AvE, Capr|corr,
EPlE3u3
ALLlAT, l0PE,
AN8P2, LlFE,
C0NvlNCE
TllAZ, 88, ACEl, AR8,
AL00 ANT
88, ACEl, AL00 ANT
TllAZ, 88, ACE, CC8
learl la||ure
Poslryocard|a|
|rlarcl|or
l|gr CA0 r|s|
0|aoeles
Crror|c ||drey d|sease
Recurrerl slro|e
preverl|or
6ompe|||ng |nd|cat|ons for
|nd|v|dua| 0rug 6|asses
6ompe|||ng |nd|cat|on |n|t|a| Therapy pt|ons 6||n|ca| Tr|a| as|s
NKF-A0A 0u|de||re,
uKP03, ALLlAT
NKF 0u|de||re,
Caplopr|| Tr|a|,
RENAAL, l0NT, RElN,
AA3K
PR00RE33
TllAZ, 88, ACE, AR8,
CC8
ACEl, AR8
TllAZ, ACEl
H|nor|ty Popu|at|ons
lr gerera|, lrealrerl s|r||ar lor a|| derograpr|c groups.
3oc|oecoror|c laclors ard ||lesly|e |rporlarl oarr|ers lo 8P corlro|.
Preva|erce, sever|ly ol lTN |rcreased |r Alr|car Arer|cars.
Alr|car Arer|cars derorslrale soreWral reduced 8P resporses lo
rorolrerapy W|lr 88s, ACEls, or AR8s corpared lo d|urel|cs or
CC8s.
Trese d|llererces usua||y e||r|raled oy add|rg adequale doses ol a
d|urel|c.
Left Ventr|cu|ar hypertrophy
Lvl |s ar |rdeperderl r|s| laclor lral |rcreases lre r|s| ol Cv0.
Regress|or ol Lvl occurs W|lr aggress|ve 8P raragererl: We|grl
|oss, sod|ur reslr|cl|or, ard lrealrerl W|lr a|| c|asses ol drugs excepl
lre d|recl vasod||alors rydra|az|re ard r|rox|d||.
Per|phera| Arter|a| 0|sease
(PA0}
PA0 |s equ|va|erl |r r|s| lo |screr|c rearl d|sease.
Ary c|ass ol drugs car oe used |r rosl PA0 pal|erls.
0lrer r|s| laclors srou|d oe raraged aggress|ve|y.
Asp|r|r srou|d oe used.
hypertens|on |n |der
Persons
Vore lrar lWo-lr|rds ol peop|e over 5 rave lTN.
Tr|s popu|al|or ras lre |oWesl rales ol 8P corlro|.
Trealrerl, |rc|ud|rg lrose Wro W|lr |so|aled syslo||c lTN, srou|d
lo||oW sare pr|rc|p|es oul||red lor gerera| care ol lTN.
LoWer |r|l|a| drug doses ray oe |rd|caled lo avo|d syrplors;
slardard doses ard ru|l|p|e drugs W||| oe reeded lo reacr 8P largels.
Postura| hypotens|on
0ecrease |r slard|rg 38P >10 rrlg, Wrer assoc|aled W|lr
d|zz|ress/la|rl|rg, rore lrequerl |r o|der 38P pal|erls W|lr d|aoeles,
la||rg d|urel|cs, verod||alors, ard sore psycrolrop|c drugs.
8P |r lrese |rd|v|dua|s srou|d oe ror|lored |r lre upr|grl pos|l|or.
Avo|d vo|ure dep|el|or ard excess|ve|y rap|d dose l|lral|or ol drugs.
0ement|a
0ererl|a ard cogr|l|ve |rpa|rrerl occur rore corror|y |r peop|e
W|lr lTN.
Reduced progress|or ol cogr|l|ve |rpa|rrerl occurs W|lr ellecl|ve
arl|ryperlers|ve lrerapy.
hypertens|on |n women
0ra| corlracepl|ves ray |rcrease 8P, ard 8P srou|d oe crec|ed
regu|ar|y. lr corlrasl, lRT does rol ra|se 8P.
0eve|oprerl ol lTNcors|der olrer lorrs ol corlracepl|or.
Pregrarl Worer W|lr lTN srou|d oe lo||oWed carelu||y. Velry|dopa,
88s, ard vasod||alors, prelerred lor lre salely ol lre lelus. ACEl ard
AR8s corlra|rd|caled |r pregrarcy.
6h||dren and Ado|escents
lTN del|red as 8P95lr percerl||e or grealer, adjusled lor age,
re|grl, ard gerder.
use ||lesly|e |rlerverl|ors l|rsl, lrer drug lrerapy lor r|grer |eve|s ol
8P or |l |rsull|c|erl resporse lo ||lesly|e rod|l|cal|ors.
0rug cro|ces s|r||ar |r cr||drer ard adu|ls, oul ellecl|ve doses are
oller sra||er.
urcorp||caled lTN rol a reasor lo reslr|cl prys|ca| acl|v|ly.
hypertens|ve Urgenc|es
and Emergenc|es
Pal|erls W|lr rar|ed 8P e|eval|ors ard acule T00 (e.g.,
ercepra|opalry, ryocard|a| |rlarcl|or, urslao|e arg|ra, pu|rorary
edera, ec|arps|a, slro|e, read lraura, ||le-lrrealer|rg arler|a|
o|eed|rg, or aorl|c d|ssecl|or) requ|re rosp|la||zal|or ard parerlera|
drug lrerapy.
Pal|erls W|lr rar|ed|y e|evaled 8P oul W|lroul acule T00 usua||y do
rol requ|re rosp|la||zal|or, oul srou|d rece|ve |rred|ale coro|ral|or
ora| arl|ryperlers|ve lrerapy.
Add|t|ona| 6ons|derat|ons |n
Ant|hypertens|ve 0rug 6ho|ces
Potent|a| favorab|e effects
Tr|az|de-lype d|urel|cs uselu| |r s|oW|rg der|rera||zal|or |r
osleoporos|s.
88s uselu| |r lre lrealrerl ol alr|a| lacryarrrylrr|as/l|or|||al|or,
r|gra|re, lryrolox|cos|s (srorl-lerr), esserl|a| lreror, or per|operal|ve
lTN.
CC8s uselu| |r Rayraud's syrdrore ard cerla|r arrrylrr|as.
A|pra-o|oc|ers uselu| |r proslal|sr.
Add|t|ona| 6ons|derat|ons |n
Ant|hypertens|ve 0rug 6ho|ces
Potent|a| unfavorab|e effects
Tr|az|de d|urel|cs srou|d oe used caul|ous|y |r goul or a r|slory ol
s|gr|l|carl ryporalrer|a.
88s srou|d oe gerera||y avo|ded |r pal|erls W|lr aslrra, reacl|ve
a|rWays d|sease, or secord- or lr|rd-degree rearl o|oc|.
ACEls ard AR8s are corlra|rd|caled |r pregrarl Worer or lrose |||e|y
lo oecore pregrarl.
ACEls srou|d rol oe used |r |rd|v|dua|s W|lr a r|slory ol arg|oedera.
A|doslerore arlagor|sls ard polass|ur-spar|rg d|urel|cs car cause
ryper|a|er|a.
|mprov|ng hypertens|on 6ontro|
Adrererce lo reg|rers
Res|slarl ryperlers|or
8trateg|es for |mprov|ng
Adherence to Reg|mens
C||r|c|ar erpalry |rcreases pal|erl lrusl, rol|val|or, ard adrererce
lo lrerapy.
Prys|c|ars srou|d cors|der lre|r pal|erls' cu|lura| oe||els ard
|rd|v|dua| all|ludes |r lorru|al|rg lrerapy.
6auses of
Res|stant hypertens|on
lrproper 8P reasurererl
Excess sod|ur |rla|e
lradequale d|urel|c lrerapy
Ved|cal|or
lradequale doses
0rug acl|ors ard |rleracl|ors (e.g., rorslero|da| arl|-|rl|arralory
drugs (N3Al0s), ||||c|l drugs, syrpalror|rel|cs, ora| corlracepl|ves)
0ver-lre-courler (0TC) drugs ard reroa| supp|ererls
Excess a|coro| |rla|e
lderl|l|ao|e causes ol lTN
Pub||c hea|th 6ha||enges
and 6ommun|ty Programs
Puo||c rea|lr approacres (e.g. reduc|rg ca|or|es, saluraled lal, ard sa|l
|r processed loods ard |rcreas|rg corrur|ly/scroo| opporlur|l|es lor
prys|ca| acl|v|ly) car acr|eve a doWrWard sr|ll |r lre d|slr|oul|or ol a
popu|al|or's 8P, lrus polerl|a||y reduc|rg roro|d|ly, rorla||ly, ard lre
||lel|re r|s| ol ar |rd|v|dua|'s oecor|rg ryperlers|ve.
Trese puo||c rea|lr approacres car prov|de ar allracl|ve opporlur|ly lo
|rlerrupl ard preverl lre corl|ru|rg cosl|y cyc|e ol rarag|rg lTN ard
|ls corp||cal|ors.
Popu|at|on-ased 8trategy
8P 0|str|but|ons
8elore
lrlerverl|or
Aller
lrlerverl|or
Reducl|or |r 38P
rrlg
2
3
5
Reducl|or
|r 8P
Reducl|or |r Vorla||ly
3lro|e Cl0 Tola|
- -1 -3
-8 -5 -1
-11 -9 -Z
8upport|ng Hater|a|s
weo s|le WWW.rr|o|.r|r.gov/
For pal|erls ard lre gerera| puo||c
'Facls Aooul lre 0A3l Eal|rg P|ar (Rev|sed Vay 2003)
'Your 0u|de lo LoWer|rg 8|ood Pressure
For rea|lr proless|ora|s
Relererce Card
3||de 3roW
web s|te
www.nh|b|.n|h.gov|
0A8h Fact 8heet
our u|de to Lower|ng
|ood Pressure
Reference 6ard