Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract

Abstract-The National High Blood Pressure Education Program presents the complete Seventh Report of the JointNational Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120 -139 mm Hg or diastolic BP 80 -89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (Ͻ140/90 mm Hg, or Ͻ130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN)

“…THZDs have long been recommended for controlling BP, with reductions in CVD outcomes, and are low‐cost agents, which can promote adherence 11, 17, 18, 19. In 2003, the JNC 7 report recommended THZDs for the treatment of stage I HTN 10. Although we observed no specific point of increase in THZD use during those years, an increase in THZD and ACEI/ARB use was observed during the period examined.…”

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

“…Lack of treatment could be addressed through employing automated means to identify and reach out to younger patients and those who had not been seen for care in the last year 14, 15. In general, there are two possible causes for lack of current treatment for hypertension: noninitiation of therapy34 or lack of persistence with therapy 35, 36. An EHR or registry generated prior and active medication list might aid in determining the prevalence of each of these causes.…”

“…For instance, failure to change or increase therapy for patients who are not at goal (“therapeutic inertia”)41, 42 can be addressed by leveraging EHRs to implement treatment algorithms and protocols,16, 28, 38 utilizing clinical decision support tools embedded within EHRs including a 2‐week follow‐up process and patient reminders,19 and changes in team care 43, 44, 45, 46. Treatment‐resistant hypertension is related to age, patient factors, and medical causes of secondary hypertension47 and can be explored by implementing streamlined referral pathways35 and pushing EHR alerts to providers when the BP is elevated 30…”

Pregnancy‐Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population‐Based Norwegian Cohort

“…Because the prescription database was established in 2004,25 MoBa deliveries before 2004 were excluded for the current analyses. Hypertension is defined as ≥140/90 mm Hg measured at ≥2 physician visits 26, 27. Antihypertensive medications are recommended after a total evaluation of blood pressure and concurrent disease and indicated if systolic blood pressure is >160 mm Hg or diastolic blood pressure is >100 mm Hg.…”