Hypertension, prehypertension and normal BP

[Guest guest]

In the last digest of posts, there was discussion about what really

constitutes hypertension, and related topics.

The most recent National Practice Guidelines for BP for physicians in

the U.S. came out in May 2003. These are the Practice Guidelines of

the Joint National Committee 7. Note that a new category,

prehypertension, was created and defined. Also note the marked

effect that increasing levels of BP have on the risk of CVD:

starting at 115/75 mm Hg, for each increment of 20/10 mm Hg, the risk

of CVD doubles. Someone with a BP of 135/85 has double the risk of

CVD than someone with 115/75 (all other things being equal). Someone

with 155/95 has four times the risk of CVD than someone with 115/75.

The oft-quoted 120/80 is not a normal BP; it is now considered

prehypertension, and requires action ( " health-promoting lifestyle

modifications " ) to prevent CVD

JAMA. 2003 May 21;289(19):2560-72. Epub 2003 May 14. Related

Articles, Links

The Seventh Report of the Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High Blood Pressure: the JNC

7 report.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr,

DW, Materson BJ, Oparil S, JT Jr, Roccella EJ; National

Heart, Lung, and Blood Institute Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood

Pressure; National High Blood Pressure Education Program Coordinating

Committee.

Department of Medicine, Boston University School of Medicine, Boston,

Mass, USA.

" The Seventh Report of the Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High Blood Pressure " provides

a new guideline for hypertension prevention and management. The

following are the key messages(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;

(2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each

increment of 20/10 mm Hg; individuals who are normotensive at 55

years of age have a 90% lifetime risk for developing hypertension;

(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; (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. Certain high-risk conditions are

compelling indications for the initial use of other antihypertensive

drug classes (angiotensin-converting enzyme inhibitors, angiotensin-

receptor blockers, beta-blockers, calcium channel blockers); (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); (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; and (7) The most effective therapy prescribed

by the most careful clinician will control hypertension only if

patients are motivated. Motivation improves when patients have

positive experiences with and trust in the clinician. Empathy builds

trust and is a potent motivator. Finally, in presenting these

guidelines, the committee recognizes that the responsible physician's

judgment remains paramount.

Publication Types:

Guideline

Practice Guideline

PMID: 12748199 [PubMed - indexed for MEDLINE]

Bob Bessen