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Key facts from the JNC 7 report
The "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC 7) provides new clinical guidelines for hypertension prevention and management. Following are the report’s key messages:
• In persons older than 50 years of age, systolic blood pressure greater than 140 mmHg is a much more important cardiovascular disease (CVD) risk factor than diastolic blood pressure.
• Beginning at 115/75 mmHg, the risk of CVD doubles with each additional increment of 20/10 mmHg. Individuals who are normotensive at age 55 have a 90% lifetime risk for developing hypertension.
• Individuals with a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg should be considered as prehypertensive and require 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 combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers).
• Most patients with hypertension will require two or more antihypertensive medications to achieve goal blood pressure (less than 140/90 mmHg, or less than 130/80 mmHg for patients with diabetes or chronic kidney disease).
• If blood pressure is more than 20/10 mmHg above goal blood pressure, consideration should be given to initiating therapy with two agents, one of which usually should be a thiazide-type diuretic.
• 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.
• In presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.