JNC 7 Report on High Blood Pressure

The JNC 7 Report By Dr. Sultan Mehmood
nThe Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Accurate BP Measurement in the Office
1. The Auscultatory method of BP measurement with a properly calibrated and validated instrument should be used.
2. Patients should be seated quietly for at least 5 minutes in a chair rather than on an examination table, with feet on the floor and arms supported at heart level.
3. Measurement of BP in the standing position is indicated periodically, especially in those at risk of postural hypotension.


1. An appropriate sized cuff (cuff bladder encircling at least 80 % of the arm) should be used to ensure accuracy.
2. At least 2 measurements should be made.
3. Systolic BP is the point at which the 1st of two or more sounds is heard (phase 1) and diastolic BP is the point before the disappearance of sounds (phase 5).


n"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides new guidelines for hypertension prevention and management.
nThe following are the key messages

TABLE:


BP
Classification
Systolic BP
(mmHg)

Diastolic BP (mmHg)
Lifestyle Modification
Without Compelling Indication
With Compelling Indication
Normal
<120
and
<80
Encourage


Prehypertension
120-139
or
80-89
Yes
No Antihypertensive drug indicated
Drugs for the compelling indications (*1)
Stage 1 hypertension
140-159
or
90-99
Yes
Thiazide-type diuretics for most; may consider ACE-inhibitor, ARB, B-blockers, CCB, or combination
Drugs for the compelling indications
Other Antihypertensive drugs (diuretics, ACE inhibitors, ARB, B-blockers, CCB) as needed
Stage 2 hypertension
>160
or
>100
Yes
2-Drugs combination for most (usually thiazide-type diuretic and ACE inhibitors or ARB or B-blockers or CCB) (*2)
Drugs for the compelling indications
Other antihypertensive drugs (diuretics, ACE inhibitors, ARB, B-blockers, CCB) as needed
*1 : Treat patients with chronic kidney disease and diabetes to BP goal of less than 130/80 mmHg
*2 : Initial combined therapy should be used cautiously in those at risk of orthostatic hypotension


n"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guidelines for hypertension prevention and management.
nThe following are the key messages
I. (1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP
II. (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg;
III. individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension

IV. (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD
V. (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes.
VI. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers,
VII. B-blockers, calcium channel blockers)

VIII. (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease);
IX. (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic;

X. (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated.
XI. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator.
XII. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.
LIFESTYLE MODIFICATIONS TO MANAGE HTN
WT. REDUCTION – BMI = 18 – 24
ADOPT DASH (Dietary approaches to stop Hypertention) EATING PLAN : DIET RICH IN FRUITS,VEGS, LOW FAT DIARY PRODUCTS, REDUCED CONTENTS OF SATURATED AND TOTAL FAT
DIETARY SODIUM REDUCTION < 6 G/DAY
PHYSICAL ACTIVITY – 30 MIN/DAY
STOP SMOKING , ALCOHOL