Source: DGNews  |  Posted 9 years ago

CHICAGO, IL -- May 14, 2003 -- New national guidelines for the prevention and treatment of high blood pressure include recommendations for a more aggressive approach for detection and control of hypertension, an approach that the guideline authors say will reduce the number of heart attacks and strokes, and save lives, according to an article in the May 21 issue of The Journal of the American Medical Association (JAMA). But, the authors add that patient motivation to adhere to effective therapies is critical to successfully achieving blood pressure goals.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is being released Wednesday, May 14 (9:30 a.m. ET) at a news conference by the National Heart, Lung, and Blood Institute, National Institutes of Health, at the J.W. Marriott in Washington, D.C.

The JNC 7 report provides guidelines for increasing awareness, prevention, treatment, and control of hypertension (high blood pressure [BP]). The JNC (which consists of a coalition of 39 major professional, public, and voluntary organizations and seven federal agencies) released its last report in 1997. The decision to develop a new report was based on four factors: "publication of many new hypertension observational studies and clinical trials; need for a new clear and concise guideline that would be useful for clinicians; need to simplify the classification of BP; and a clear recognition that the JNC reports were not being used to their maximum benefit."

The key messages for JNC 7 for hypertension prevention and management are:

(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 (normal blood pressure) at 55 years of age have a 90 percent 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 [ACE] inhibitors, angiotensin-receptor blockers, beta-blockers, and calcium channel blockers).

(5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (less than 140/90 mm Hg, or less than 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.

(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."

The authors note that public health approaches, such as reducing calories, saturated fat, and salt in processed foods and increasing community and school opportunities for physical activity, can improve the population's BP, and thus potentially reducing the lifetime risk of an individual becoming hypertensive, and the associated illness and increased risk of death. They add that this becomes especially critical as the body mass index (BMI) of U.S. patients has increased to epidemic levels. Currently, 122 million adults are overweight or obese, which contributes to the rise in BP and related conditions.

"The JNC 7 endorses the American Public Health Association resolution that the food manufacturers and restaurants reduce sodium in the food supply by 50 percent during the next decade. When public health intervention strategies address the diversity of racial, ethnic, cultural, linguistic, religious, and social factors in the delivery of their services, the likelihood of their acceptance by the community increases. These public health approaches can provide an attractive opportunity to interrupt and prevent the continuing costly cycle of managing hypertension and its complications."

(JAMA. 2003; 289:2560-2572. Available post-embargo at jama.com)

Editor's Note: This work was supported entirely by the National Heart, Lung, and Blood Institute. The executive committee, writing teams, and reviewers served as volunteers without remuneration. For the financial disclosures of the authors, please see the JAMA article.

SOURCE: JAMA/Archives Media Relations Department