The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure<SUBTITLE>The JNC 7 Report</SUBTITLE>
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Abstract
"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.