Cover of the guidelines report
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
Published Dec 2003
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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.

  • Publication Date: December 2003 in Hypertension. 2003;42:1206
  • Version History:
    • JNC 6:  published 1997
    • JNC 5:  published 1992
    • JNC 4:  published 1988
    • JNC 3:  published 1984
    • JNC 2:  published 1980
    • JNC 1:  published 1976

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.

  • Publication Date: December 2003 in Hypertension. 2003;42:1206
  • Version History:
    • JNC 6:  published 1997
    • JNC 5:  published 1992
    • JNC 4:  published 1988
    • JNC 3:  published 1984
    • JNC 2:  published 1980
    • JNC 1:  published 1976

Methodology

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.

Expert Panel Members

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

Expert Reviewers

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

Conflicts of Interest

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.

Text-only Slide Set of the Report

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) EXPRESS Slide Set

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)

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