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This complete version of the updated guidelines for hypertension is written for the health care professional who wants to understand the science behind the new recommendations on high blood pressure. The JNC 7 Complete Report focuses on the new evidence, including a revised treatment algorithm, drug tables, and more. Get this for the health professional or researcher who needs to understand the full scope and significance of the new findings on high blood pressure.
This complete version of the updated guidelines for hypertension is written for the health care professional who wants to understand the science behind the new recommendations on high blood pressure. The JNC 7 Complete Report focuses on the new evidence, including a revised treatment algorithm, drug tables, and more. Get this for the health professional or researcher who needs to understand the full scope and significance of the new findings on high blood pressure.
The decision to appoint a committee for JNC 7 was based on four factors: the publication of many new hypertension observational studies and clinical trials since the last report was published in 1997; the need for a new, clear, and concise guideline that would be useful to clinicians; the need to simplify the classification of BP; and a clear recognition that the JNC reports did not result in maximum benefit to the public. This JNC report is presented in two separate publications. The initial "Express" version, a succinct practical guide, was published in the May 21, 2003 issue of the Journal of the American Medical Association. The current, more comprehensive report provides a broader discussion and justification for the recommendations made by the committee. As with prior JNC reports, the committee recognizes that the responsible physician's judgment is paramount in managing his or her patients.
Since the publication of the JNC 6 report, the NHBPEP Coordinating Committee, chaired by the director of the NHLBI, has regularly reviewed and discussed studies on hypertension. To conduct this task, the Coordinating Committee is divided into four subcommittees: science base; long-range planning; professional, patient, and public education; and program organization. The subcommittees work together to review the hypertension scientific literature from clinical trials, epidemiology, and behavioral science. In many instances, the principal investigator of the larger studies has presented the information directly to the Coordinating Committee. The committee reviews are summarized and posted on the NHLBI Web site. This ongoing review process keeps the committee apprised of the current state of the science, and the information is also used to develop program plans for future activities, such as continuing education.
During fall 2002, the NHBPEP Coordinating Committee chair solicited opinions regarding the need to update the JNC 6 report. The entire Coordinating Committee provided, in writing, a detailed rationale explaining the necessity for updating JNC 6, outlined critical issues, and provided concepts to be addressed in the new report. Thereafter, the NHBPEP Coordinating Committee chair appointed the JNC 7 chair and an Executive Committee derived from the Coordinating Committee membership. The Coordinating Committee members served on one of five JNC 7 writing teams, which contributed to the writing and review of the document.
The concepts for the new report identified by the NHBPEP Coordinating Committee were used to create the report outline. Based on these critical issues and concepts, the Executive Committee developed relevant medical subject headings (MeSH) terms and keywords to further review the scientific literature. These MeSH terms were used to generate MEDLINE searches that focused on English-language, peer-reviewed, scientific literature from January 1997 through April 2003. Various systems of grading the evidence were considered, and the classification scheme used in JNC 6 and other NHBPEP clinical guidelines was selected. This scheme classifies studies according to a process adapted from Last and Abramson (see Scheme Used for Classification of the Evidence).
In reviewing the exceptionally large body of research literature on hypertension, the Executive Committee focused its deliberations on evidence pertaining to outcomes of importance to patients and with effects of sufficient magnitude to warrant changes in medical practice ("patientoriented evidence that matters," or POEMs). Patient-oriented outcomes include not only mortality but also other outcomes that affect patients' lives and well-being, such as sexual function, ability to maintain family and social roles, ability to work, and ability to carry out daily living activities. These outcomes are strongly affected by nonfatal stroke, HF, CHD, and renal disease; hence, these outcomes were considered along with mortality in the committee's evidencebased deliberations. Studies of physiological endpoints ("disease-oriented evidence," or DOEs) were used to address questions where POEMs were not available.
The Coordinating Committee began the process of developing the JNC 7 Express report in December 2002, and the report was submitted to the Journal of the American Medical Association in April 2003. It was published in an electronic format on May 14, 2003, and in print on May 21, 2003. During this time, the Executive Committee met on six occasions, two of which included meetings with the entire NHBPEP Coordinating Committee. The writing teams also met by teleconference and used electronic communications to develop the report. Twenty-four drafts were created and reviewed repeatedly. At its meetings, the Executive Committee used a modified nominal group process14 to identify and resolve issues. The NHBPEP Coordinating Committee reviewed the penultimate draft and provided written comments to the Executive Committee. In addition, 33 national hypertension leaders reviewed and commented on the document. The NHBPEP Coordinating Committee approved the JNC 7 Express report. To complete the longer JNC 7 version, the Executive Committee members met via teleconferences and in person and circulated sections of the larger document via e-mail. The sections were assembled and edited by the JNC 7 chair and were circulated among the NHBPEP Coordinating Committee members for review and comment. The JNC 7 chair synthesized the comments, and the longer version was submitted to the journal Hypertension in November 2003.
Chair
Aram V. Chobanian, M.D.
Boston University School of Medicine
Boston, MA
Executive Committee
George L. Bakris, M.D.
Rush University Medical Center
Chicago, IL
Henry R. Black, M.D.
Rush University Medical Center
Chicago, IL
William C. Cushman, M.D.
Veterans Affairs Medical Center, Memphis, TN
Lee A. Green, M.D., M.P.H.
University of Michigan
Ann Arbor, MI
Joseph L. Izzo, Jr., M.D.
State University of New York at Buffalo School of Medicine
Buffalo, NY
Daniel W. Jones, M.D.
University of Mississippi Medical Center
Jackson, MS
Barry J. Materson, M.D., M.B.A.
University of Miami, Miami, FL
Suzanne Oparil, M.D.
University of Alabama at Birmingham
Birmingham, AL
Jackson T. Wright, Jr., M.D., Ph.D.
Case Western Reserve University
Cleveland, OH
Executive Secretary
Edward J. Roccella, Ph.D., M.P.H.
National Heart, Lung, and Blood Institute
Bethesda, MD
National High Blood Pressure Education Program Coordinating Committee
Claude Lenfant, M.D.
National Heart, Lung, and Blood Institute
Bethesda, MD
George L. Bakris, M.D.
Rush University Medical Center
Chicago, IL
Henry R. Black, M.D.
Rush University Medical Center
Chicago, IL
Vicki Burt, Sc.M., R.N.
National Center for Health Statistics
Hyattsville, MD
Barry L. Carter, Pharm.D., F.C.C.P.
University of Iowa
Iowa City, IA
Francis D. Chesley, Jr., M.D.
Agency for Healthcare Research and Quality
Rockville, MD
Jerome D. Cohen, M.D.
Saint Louis University School of Medicine
St. Louis, MO
Pamela J. Colman, D.P.M.
American Podiatric Medical Association
Bethesda, MD
William C. Cushman, M.D.
Veterans Affairs Medical Center
Memphis, TN
Mark J. Cziraky, Pharm.D., F.A.H.A.
Health Core, Inc.
Newark, DE
John J. Davis, P.A.-C.
American Academy of Physician Assistants
Memphis, TN
Keith Copelin Ferdinand, M.D., F.A.C.C.
Heartbeats Life Center
New Orleans, LA
Ray W. Gifford, Jr., M.D., M.S.
Cleveland Clinic Foundation
Fountain Hills, AZ
Michael Glick, D.M.D.
New Jersey Dental School
Newark, NJ
Lee A. Green, M.D., M.P.H.
University of Michigan
Ann Arbor, MI
Stephen Havas, M.D., M.P.H., M.S.
University of Maryland School of Medicine
Baltimore, MD
Thomas H. Hostetter, M.D.
National Institutes of Diabetes and Digestive and Kidney Diseases
Bethesda, MD
Joseph L. Izzo, Jr., M.D.
State University of New York at Buffalo School of Medicine
Buffalo, NY
Daniel W. Jones, M.D.
University of Mississippi Medical Center
Jackson, MS
Lynn Kirby, R.N., N.P., C.O.H.N.
Sanofi-Synthelabo Research
Malvern, PA
Kathryn M. Kolasa, Ph.D., R.D., L.D.N.
Brody School of Medicine at East Carolina University
Greenville, NC
Stuart Linas, M.D.
University of Colorado Health Sciences Center
Denver, CO
William M. Manger, M.D., Ph.D.
New York University Medical Center
New York, NY
Edwin C. Marshall, O.D., M.S., M.P.H.
Indiana University School of Optometry
Bloomington, IN
Barry J. Materson, M.D., M.B.A.
University of Miami
Miami, FL
Jay Merchant, M.H.A.
Centers for Medicare & Medicaid Services
Washington, DC
Nancy Houston Miller, R.N., B.S.N.
Stanford University School of Medicine
Palo Alto, CA
Marvin Moser, M.D.
Yale University School of Medicine
Scarsdale, NY
William A. Nickey, D.O.
Philadelphia College of Osteopathic Medicine
Philadelphia, PA
Suzanne Oparil, M.D.
University of Alabama at Birmingham
Birmingham, AL
Otelio S. Randall, M.D., F.A.C.C.
Howard University Hospital
Washington, DC
James W. Reed, M.D., F.A.C.P., F.A.C.E.
Morehouse School of Medicine
Atlanta, GA
Edward J. Roccella, Ph.D., M.P.H.
National Heart, Lung, and Blood Institute
Bethesda, MD
Lee Shaughnessy
National Stroke Association
Englewood, CO
Sheldon G. Sheps, M.D.
Mayo Clinic, Rochester, MN
David B. Snyder, R.Ph., D.D.S.
Health Resources and Services Administration
Rockville, MD
James R. Sowers, M.D., F.A.C.P., F.A.C.E.
SUNY Health Science Center at Brooklyn
Brooklyn, NY
Leonard M. Steiner, M.S., O.D.
Eye Group
Oakhurst, NJ
Ronald Stout, M.D., M.P.H.
Procter and Gamble
Mason, OH
Rita D. Strickland, Ed.D., R.N.
New York Institute of Technology
Springfield Gardens, NY
Carlos Vallbona, M.D.
Baylor College of Medicine
Houston, TX
Howard S. Weiss, M.D., M.P.H.
Georgetown University Medical Center
Washington Hospital Center
Walter Reed Army Medical Center
Washington, DC
Jack P. Whisnant, M.D.
Mayo Clinic and Mayo Medical School
Rochester, MN
Laurie Willshire, M.P.H., R.N.
American Red Cross
Falls Church, VA
Gerald J. Wilson, M.A., M.B.A.
Citizens for Public Action on Blood Pressure and Cholesterol, Inc.
Potomac, MD
Mary Winston, Ed.D., R.D.
American Heart Association
Dallas, TX
Jackson T. Wright, Jr., M.D., Ph.D.
Case Western Reserve University
Cleveland, OH
Additional Contributors
Jan N. Basile, M.D., F.A.C.P.
Veterans Administration Hospital
Charleston, SC
James I. Cleeman, M.D.
National Heart, Lung, and Blood Institute
Bethesda, MD
Darla E. Danford, M.P.H, D.Sc.
National Heart, Lung, and Blood Institute
Bethesda, MD
Richard A. Dart, M.D., F.A.C.P., F.C.C.P., F.A.H.A.
Marshfield Clinic
Marshfield, WI
Karen A. Donato, S.M., R.D.
National Heart, Lung, and Blood Institute
Bethesda, MD
Mark E. Dunlap, M.D.
Louis Stokes Cleveland VA Medical Center
Cleveland, OH
Brent M. Egan, M.D.
Medical University of South Carolina
Charleston, SC
William J. Elliott, M.D., Ph.D.
Rush University Medical Center
Chicago, IL
Bonita E. Falkner, M.D.
Thomas Jefferson University
Philadelphia, PA
John M. Flack, M.D., M.P.H.
Wayne State University School of Medicine
Detroit, MI
David Lee Gordon, M.D.
University of Miami School of Medicine
Miami, FL
Philip B. Gorelik, M.D., M.P.H., F.A.C.P.
Rush Medical College
Chicago, IL
Mary M. Hand, M.S.P.H., R.N
National Heart, Lung, and Blood Institute
Bethesda, MD
Linda A. Hershey, M.D., Ph.D.
VA WNY Healthcare System
Buffalo, NY
Norman M. Kaplan, M.D.
University of Texas Southwestern Medical School at Dallas
Dallas, TX
Daniel Levy, M.D.
National Heart, Lung, and Blood Institute
Framingham, MA
James W. Lohr, M.D.
VA WNY Healthcare System and SUNY Buffalo
Buffalo, NY
Vasilios Papademetriou, M.D., F.A.C.P., F.A.C.C.
Veterans Affairs Medical Center
Washington, DC
Thomas G. Pickering, M.D., D.Phil.
Mount Sinai Medical Center
New York, NY
Ileana L. Piña, M.D., F.A.C.C.
University Hospitals of Cleveland
Cleveland, OH
L. Michael Prisant, M.D., F.A.C.C., F.A.C.P.
Medical College of Georgia
Augusta, GA
Clive Rosendorff, M.D., Ph.D., F.R.C.P.
Veterans Affairs Medical Center
Bronx, NY
Virend K. Somers, M.D., Ph.D.
Mayo Clinic and Mayo Foundation
Rochester, MN
Ray Townsend, M.D.
University of Pennsylvania School of Medicine,
Philadelphia, PA
Humberto Vidaillet, M.D.
Marshfield Clinic
Marshfield, WI
Donald G. Vidt, M.D.
Cleveland Clinic Foundation
Cleveland, OH
William White, M.D.
The University of Connecticut Health Center
Farmington, CT
William B. Applegate, M.D., M.P.H.
Wake Forest University School of Medicine
Winston Salem, NC
Jan N. Basile, M.D., F.A.C.P.
Veterans Administration Hospital
Charleston, SC
Robert Carey, M.D.,
University of Virginia Health System
Charlottesville, VA
Victor Dzau, M.D.
Brigham and Women's Hospital
Boston, MA
Brent M. Egan, M.D.
Medical University of South Carolina
Charleston, SC
Bonita Falkner, M.D.
Jefferson Medical College
Philadelphia, PA
John M. Flack, M.D., M.P.H.
Wayne State University School of Medicine
Detroit, MI
Edward D. Frohlich, M.D.
Ochsner Clinic Foundation
New Orleans, LA
Haralambos Gavras, M.D.
Boston University School of Medicine
Boston, MA
Martin Grais, M.D.
Feinberg School of Medicine, Northwestern University
Chicago, IL
Willa A. Hsueh, M.D.
David Geffen School of Medicine
UCLA Department of Medicine
Los Angeles, CA
Kenneth A. Jamerson, M.D.
University of Michigan Medical Center
Ann Arbor, MI
Norman M. Kaplan, M.D.
University of Texas Southwestern Medical Center
Dallas, TX
Theodore A. Kotchen, M.D.
Medical College of Wisconsin
Milwaukee, WI
Daniel Levy, M.D.
National Heart, Lung, and Blood Institute
Framingham, MA
Michael A. Moore, M.D.
Dan River Region Cardiovascular Health Initiative Program
Danville, VA
Thomas J. Moore, M.D.
Boston University Medical Center
Boston, MA
Vasilios Papademetriou, M.D., F.A.C.P., F.A.C.C.
Veterans Affairs Medical Center
Washington, DC
Carl J. Pepine, M.D.
University of Florida, College of Medicine
Gainesville, FL
Robert A. Phillips, M.D., Ph.D.
New York University, Lenox Hill Hospital
New York, NY
Thomas G. Pickering, M.D., D.Phil.
Mount Sinai Medical Center
New York, NY
L. Michael Prisant, M.D., F.A.C.C., F.A.C.P.
Medical College of Georgia
Augusta, GA
C. Venkata S. Ram, M.D.
University of Texas Southwestern Medical Center and Texas Blood Pressure Institute
Dallas, TX
Elijah Saunders, M.D., F.A.C.C., F.A.C.P.
University of Maryland School of Medicine
Baltimore, MD
Stephen C. Textor, M.D.
Mayo Clinic
Rochester, MN
Donald G. Vidt, M.D.
Cleveland Clinic Foundation
Cleveland, OH
Myron H. Weinberger, M.D.
Indiana University School of Medicine
ndianapolis, IN
Paul K. Whelton, M.D., M.Sc.
Tulane University Health Sciences Center
New Orleans, LA
Dr. Chobanian has received honoraria for serving as a speaker from Monarch, Wyeth, Astra- Zeneca, Solvay, and Bristol-Myers Squibb.
Dr. Bakris has received honoraria for serving as a speaker from Astra-Zeneca, Abbott, Alteon, Biovail, Boerhinger-Ingelheim, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Merck, Novartis, Sanofi, Sankyo, and Solvay; he has received funding/grant support for research projects from National Institutes of Health, Astra- Zeneca, Abbott, Alteon, Boerhinger-Ingelheim, Forest, GlaxoSmithKline, Merck, Novartis, Sankyo, and Solvay; he has served as a consultant/ advisor for Astra-Zeneca, Abbott, Alteon, Biovail, Boerhinger-Ingelheim, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Merck, Novartis, Sanofi, Sankyo, and Solvay.
Dr. Black has received honoraria for serving as a speaker from Astra-Zeneca, Bristol-Myers Squibb, Novartis, Pfizer, Pharmacia, and Wyeth-Ayerst; he has received funding/grant support for research projects from Bristol-Myers Squibb, Boehringer- Ingelheim, Merck, Pfizer, and Pharmacia; he has served as a consultant/advisor for Abbott, Astra- Zeneca, Biovail, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Pfizer, and Pharmacia.
Dr. Carter has served as a consultant/advisor for Bristol-Myers Squibb.
Dr. Cushman has received funding/grant support for research projects from Astra-Zeneca, Merck, Pfizer, Kos, Aventis Pharma, King Pharmaceuticals, GlaxoSmithKline, and Boehringer-Ingelheim; he has served as a consultant/ advisor for Bristol-Myers Squibb, Sanofi, GlaxoSmithKline, Novartis, Pfizer, Solvay, Pharmacia, Takeda, Sankyo, Forest, and Biovail.
Dr. Izzo has received honoraria for serving as a speaker from Boehringer-Ingelheim, Merck, Pfizer, Astra-Zeneca, Solvay, Novartis, Forest, and Sankyo; he has received funding/grant support for research projects from Boehringer-Ingelheim, Merck, Astra-Zeneca, Novartis, GlaxoSmithKline, and Biovail; he served as a consultant/advisor for Merck, Astra-Zeneca, Novartis, Intercure, Sankyo, and Nexcura; he has stock holdings in Intercure, Nexcura.
Dr. Jones has served as a consultant/advisor for Pfizer, Bristol-Myers Squibb, Merck, Forest, and Novartis.
Dr. Manger has served as a consultant/advisor for the NHBPEP Coordinating Committee.
Dr. Materson has served as a consultant/advisor for Unimed, Merck, GlaxoSmithKline, Novartis, Reliant, Tanabe, Bristol-Myers Squibb, Pfizer, Pharmacia, Noven, Boehringer-Ingelheim, and Solvay.
Dr. Oparil has received funding/grant support for research projects from Abbott Laboratories, Astra-Zeneca, Aventis, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Forest, GlaxoSmithKline, Monarch, Novartis [Ciba], Merck, Pfizer, Sanofi/BioClin, Schering Plough, Schwarz Pharma, Scios Inc, GD Searle, Wyeth Ayerst, Sankyo, Solvay, and Texas Biotechnology Corporation; she has served as a consultant/advisor for Bristol-Myers Squibb, Merck, Pfizer, Sanofi, Novartis, The Salt Institute, and Wyeth- Ayerst; she is also on the Board of Directors for the Texas Biotechnology Corporation.
Dr. Sowers has received honoraria for serving as a speaker from Med Com Vascular Biology Working Group and Joslin Clinic Foundation; he has received funding/grant support for research projects from Novartis and Astra-Zeneca.
Dr. Wright has received honoraria for serving as a speaker from Astra, Aventis, Bayer, Bristol-Myers Squibb, Forest, Merck, Norvartis, Pfizer, Phoenix Pharmaceuticals, GlaxoSmithKline, and Solvay/Unimed; he has received funding/grant support for research projects from Astra, Aventis, Bayer, Biovail, Bristol-Myers Squibb, Forest, Merck, Norvartis, Pfizer, Phoenix Pharmaceuticals, GlaxoSmithKline, and Solvay/Unimed.
Title Page--Department of Health and Human Services
National Institutes of Health
National Heart, Lung, and Blood Institute
National High Blood Pressure Education Program
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
I. Introduction
II. Measurement and Evaluation
9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 |
III. Treatment
24 | 25 | 26 | 27 | 28 | 29 | 30 |
IV. Special Considerations
31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 43 | 44 |
V. Improving Hypertension Control
45 | 46 | 47 | 48 | 49 | 50 | 51 | 52 | 53 | 54
SLIDE 1: National Heart, Lung, and Blood Institute National High Blood Pressure Education Program
Seventh Report of the Joint National Committee onPrevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) EXPRESS
SLIDE 2: Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Executive Committee
Aram Chobanian, M.D., Chair Dean?s Office and Department of Medicine Boston University School of Medicine
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SLIDE 3: National High Blood Pressure Education Program Coordinating Committee
American Academy of Family Physicians
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Physician Assistants
American Association of Occupational Health Nurses
American College of Cardiology
American College of Chest Physicians
American College of Occupational and Environmental Medicine
American College of Physicians
?American Society of Internal Medicine
American College of Preventive Medicine
American Dental Association
American Diabetes Association
American Dietetic Association
American Heart Association
American Hospital Association
American Medical Association
American Nurses Association
American Optometric Association
American Osteopathic Association
American Pharmaceutical Association
American Podiatric Medical Association
American Public Health Association
American Red Cross
American Society of Health-System Pharmacists
American Society of Hypertension
American Society of Nephrology
Association of Black Cardiologists
Citizens for Public Action on High Blood Pressure and Cholesterol, Inc.
Hypertension Education Foundation, Inc.
International Society on Hypertension in Blacks
National Black Nurses Association, Inc.
National Hypertension Association, Inc.
National Kidney Foundation, Inc.
National Medical Association
National Optometric Association
National Stroke Association
NHLBI Ad Hoc Committee on Minority Populations
Society for Nutrition Education
The Society of Geriatric Cardiology
Federal Agencies:
Agency for Healthcare Research and Quality
Centers for Medicare & Medicaid Services
Department of Veterans Affairs
Health Resources and Services Administration
National Center for Health Statistics
National Heart, Lung, and Blood Institute
National Institute of Diabetes and Digestive and Kidney Diseases
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SLIDE 4: JNC 7
SLIDE 5: Purpose
Why JNC 7?
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SLIDE 6: New Features and Key Messages
SLIDE 7: New Features and Key Messages (Continued)
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SLIDE 8: New Features and Key Messages (Continued)
SLIDE 9: BP Measurement and Clinical Evaluation
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SLIDE 10: Blood Pressure Classification
BP Classification | SBP mmHg | DBP mmHg | |
---|---|---|---|
Normal | <120 | and | <80 |
Prehypertension | 120?139 | or | 80?89 |
Stage 1 Hypertension | 140?159 | or | 90?99 |
Stage 2 Hypertension | [[nid:845 view_mode=custom_size width=13 height=14]]160 | or | [[nid:845 view_mode=custom_size width=13 height=14]]100 |
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SLIDE 11: CVD Risk
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SLIDE 12: Benefits of Lowering BP
Average Percent Reduction | |
---|---|
Stroke incidence | 35?40% |
Myocardial infarction | 35?40% |
Heart failure | 50% |
SLIDE 13: 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.
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SLIDE 14: BP Control Rates
Trends in awareness, treatment, and control of high blood pressure in adults ages 18?74
Trends in awareness, treatment, and control of high blood pressure in adults ages 18?74 | ||||
---|---|---|---|---|
II 1976?80 |
II (Phase 1) 1988?91 |
II (Phase 2) 1991?94 |
1999?2000 | |
Awareness | 51 | 73 | 68 | 70 |
Treatment | 31 | 55 | 54 | 59 |
Control | 10 | 29 | 27 | 34 |
SLIDE 15: BP Measurement Techniques
Method | Brief Description |
---|---|
In-office | Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm. |
Ambulatory BP monitoring | Indicated for evaluation of ?white-coat? HTN. Absence of 10?20% BP decrease during sleep may indicate increased CVD risk. |
Self-measurement | Provides information on response to therapy. May help improve adherence to therapy and evaluate ?white-coat? HTN. |
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SLIDE 16: Office BP Measurement
SLIDE 17: Ambulatory BP Monitoring
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SLIDE 18: Self-Measurement of BP
SLIDE 19: Patient Evaluation
Evaluation of patients with documented HTN has three objectives:
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SLIDE 20: CVD Risk Factors
*Components of the metabolic syndrome.
SLIDE 21: Identifiable Causes of Hypertension
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SLIDE 22: Target Organ Damage
SLIDE 23: Laboratory Tests
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SLIDE 24: TreatmentOverview
SLIDE 25: Goals of Therapy
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SLIDE 26: Lifestyle Modification
Modification | Approximate SBP reduction(range) |
---|---|
Weight reduction | 5?20 mmHg/10 kg weight loss |
Adopt DASH eating plan | 8?14 mmHg |
Dietary sodium reduction | 2?8 mmHg |
Physical activity | 4?9 mmHg |
Moderation of alcohol consumption | 2?4 mmHg |
SLIDE 27: Algorithm for Treatment of Hypertension
Initial drug therapy | |||||
---|---|---|---|---|---|
BP classification | SBP* mmHg | DBP* mHg | Lifestyle modification | Without compelling indication | With compelling indications |
Normal | <120 | and <80 | Encourage | ||
Prehypertension | 120?139 | or 80?89 | Yes | No antihypertensive drug indicated. | Drug(s) for compelling indications.*** |
Stage 1 Hypertension | 140?159 | or 90?99 | Yes | Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. | Drug(s) for the compelling indications.*** Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. |
Stage 2 Hypertension | [[nid:845 view_mode=custom_size width=13 height=14]]160 | or [[nid:845 view_mode=custom_size width=13 height=14]]100 | Yes | Two-drug combination for most** (usually thiazide-type diuretic and ACEI or ARB or BB or CCB). | Drug(s) for the compelling indications.*** Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. |
*Treatment determined by highest BP category.
**Initial 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.
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SLIDE 28: Classification and Management of BP for adults
Initial drug therapy | |||||
---|---|---|---|---|---|
BP classification | SBP* mmHg | DBP* mHg | Lifestyle modification | Without compelling indication | With compelling indications |
Normal | <120 | and <80 | Encourage | ||
Prehypertension | 120?139 | or 80?89 | Yes | No antihypertensive drug indicated. | Drug(s) for compelling indications.*** |
Stage 1 Hypertension | 140?159 | or 90?99 | Yes | Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. | Drug(s) for the compelling indications.*** Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. |
Stage 2 Hypertension | [[nid:845 view_mode=custom_size width=13 height=14]]160 | or [[nid:845 view_mode=custom_size width=13 height=14]]100 | Yes | Two-drug combination for most** (usually thiazide-type diuretic and ACEI or ARB or BB or CCB). | Drug(s) for the compelling indications.*** Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. |
*Treatment determined by highest BP category.
**Initial 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.
SLIDE 29: Followup and Monitoring
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SLIDE 30: Followup and Monitoring(continued)
SLIDE 31: Special Considerations
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SLIDE 32: Compelling Indications for Individual Drug Classes
Compelling Indication | Initial Therapy Options | Clinical Trial Basis |
---|---|---|
Heart failure | THIAZ, BB, ACEI, ARB, ALDO ANT | ACC/AHA Heart Failure Guideline, MERIT-HF, COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES |
Postmyocardialinfarction | BB, ACEI, ALDO ANT | ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS |
High CAD risk | THIAZ, BB, ACE, CCB | ALLHAT, HOPE, ANBP2, LIFE, CONVINCE |
SLIDE 33: Compelling Indications for Individual Drug Classes
Compelling Indication | Initial Therapy Options | Clinical Trial Basis |
---|---|---|
Diabetes | THIAZ, BB, ACE, ARB, CCB | NKF-ADA Guideline, UKPDS, ALLHAT |
Chronic kidney disease | ACEI, ARB | NKF Guideline, Captopril Trial, RENAAL, IDNT, REIN, AASK |
Recurrent stroke prevention | THIAZ, ACEI | PROGRESS |
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SLIDE 34: Minority Populations
SLIDE 35: Left Ventricular Hypertrophy
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SLIDE 36: Peripheral Arterial Disease(PAD)
SLIDE 37: Hypertension in OlderPersons
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SLIDE 38: Postural Hypotension
SLIDE 39: Dementia
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SLIDE 40: Hypertension in Women
SLIDE 41: Children and Adolescents
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SLIDE 42: Hypertensive Urgencies and Emergencies
SLIDE 43: Additional Considerations in Antihypertensive Drug Choices
Potential favorable effects
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SLIDE 44: Additional Considerations in Antihypertensive Drug Choices
Potential unfavorable effects
SLIDE 45: Improving Hypertension Control
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SLIDE 46: Strategies for Improving Adherence to Regimens
SLIDE 47: Causes of Resistant Hypertension
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SLIDE 48: Public Health Challenges and Community Programs
SLIDE 49: Population-Based Strategy
SBP Distributions
% Reduction in Mortality | |||
---|---|---|---|
Reduction in SBP mmHg | Stroke | CHD | Total |
2 | ?6 | ?4 | ?3 |
3 | ?8 | ?5 | ?4 |
5 | ?14 | ?9 | ?7 |
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SLIDE 50: Supporting Materials
SLIDE 51: Web sitewww.nhlbi.nih.gov/
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SLIDE 52: DASH Fact Sheet
SLIDE 53: Your Guide to Lowering Blood Pressure
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SLIDE 54: Reference Card
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