JNC 7: Treatment Algorithm for Hypertension

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  • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has issued new recommendations for the management of hypertension (identified as a major risk factor for coronary heart disease by the NCEP ATP III guidelines). Treatment is determined by the highest blood pressure (BP) category obtained as the average of two or more accurate in-office BP measurements on each of two or more visits. 
  • Key messages from the report include the following.
    • In individuals >50 years of age, systolic BP (SBP) >140 mm Hg is a “much more important” cardiovascular disease (CVD) risk factor than diastolic BP (DBP).
    • The risk for CVD beginning at 115/75 mm Hg doubles with each increment of 20/10 mm Hg; individuals who are normotensive at age 55 have a 90% lifetime risk of developing hypertension.
    • Individuals with a SBP of 120–139 mm Hg or a DBP of 80–89 mm Hg should be considered prehypertensive, reflecting an increased risk of future hypertension and requiring health-promoting lifestyle modifications to prevent CVD.
    • Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or in combination with drugs from other classes. Certain high-risk conditions, including postmyocardial infarction, diabetes, and chronic kidney disease, are compelling indications for the initial use of other antihypertensive drug classes (ie, angiotensin-converting enzyme inhibitor; angiotensin receptor blocker; b-blocker; calcium channel blocker). The compelling indication is managed parallel with
      the BP.
    • Most patients with hypertension will require two or more antihypertensive drugs to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease).
    • If BP is >20/10 mm Hg above goal BP, consider initiating therapy with two agents, one of which should usually be a thiazide-type diuretic.
    • A physician’s judgment remains paramount to these guidelines. 

JNC 7. May 2003. NIH publication 03-5233.