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.
Purpose: To evaluate a patient for hypertension using the recommendations of the JNC 7 report.
Specialty: Cardiology
Objective: other testing, severity, prognosis, stage
ICD-10: I10, I11, I12, I13, I15,
