Description

The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has published its 7th report. This includes a classification of hypertension and recommendations for management.


 

Parameters:

(1) systolic and diastolic blood pressure

(2) presence of compelling indications (comorbid conditions)

Systolic and Diastolic Blood Pressures

Classification

systolic < 120 mm Hg and diastolic < 80 mg Hg

normal

systolic 120 - 139 mm Hg or diastolic 80 - 89 mg Hg

prehypertension

systolic 140 - 159 mm Hg or diastolic 90 - 99 mg Hg

stage 1 hypertension

systolic >= 160 mm Hg or diastolic >= 100 mg Hg

stage 2 hypertension

 

Compelling indications include:

(1) heart failure

(2) status post myocardial infarction

(3) diabetes mellitus

(4) chronic kidney disease

(5) recurrent stroke prevention

 

Blood Pressure Classification

Lifestyle Change

HT Therapy if Compelling Condition Absent

HT Therapy if Compelling Condition Present

normal

encourage

none

none

prehypertension

yes

none

none

stage 1 hypertension

yes

thiazide diuretic for most; consider alternative agent

one or more agents as needed

stage 2 hypertension

yes

2 drug combination for most

one or more agents as needed

 

where:

• HT = hypertensive

 

Lifestyle modification includes weight loss if obese, reduction in sodium intake, adoption of the DASH (Dietary Approaches to Stop Hypertension) eating plan; physical activity and moderation of alcohol consumption.

 

Drug therapy may include include ACE inhibitor, angiotensin receptor blocker, beta blocker, calcium channel blocker or a combination of these agents. If a combination of drugs is used, starting therapy could be done carefully in patients at risk for orthostatic hypotension.

 

Therapy also includes treatment of the compelling condition(s) present.

 

Targets:

(1) For patients with chronic kidney disease or diabetes mellitus is a systolic blood pressure < 130 mm Hg and diastolic blood pressure < 80 mm Hg.

(2) For other patients the goal is a systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg.

 


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