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Blood Pressure Guidelines
In 2003, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure issued a new set of consensus guidelines for the assessment and treatment of high blood pressure, known as JNC 7.2 The revised guidelines are based on new evidence of the risk for the development of cardiovascular disease (CVD; includes CAD, stroke, and peripheral artery disease) and other outcomes associated with varying levels of blood pressure. |
In general, these guidelines recognize two categories of high blood pressure (hypertension) with different levels of risk, and for which different treatment programs are recommended. In addition, a new category known as prehypertension has been added; patients in this category have an increased risk of progressing to hypertension.
The various categories of hypertension, as well as recommendations for management, are listed below. Treatment recommendations for each blood pressure category are based on the absence or presence of “compelling indications;” in the presence of these medical conditions, treatment is more aggressive. The compelling indications for more aggressive treatment are:
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Heart failure |
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History of myocardial infarction |
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High risk for CAD |
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Diabetes |
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Chronic kidney disease |
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History of stroke |
| Depending on the blood pressure category, treatment consists of lifestyle management augmented, if necessary, with drug therapy. Lifestyle management includes: |
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Weight reduction |
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Dietary modification (rich in fruits/vegetables, low fat) |
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Dietary sodium reduction |
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Increase physical activity |
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Moderation of alcohol consumption |
Classification and Management of Blood Pressure For Adults
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Management
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Initial Drug Therapy
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BP Classification
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Systolic BP*, mmHg
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Diastolic BP*, mmHg
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Lifestyle Modification
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Without Compelling Indication
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With Compelling Indications
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Normal
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<120
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and
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<80
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Encourage
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Prehypertension
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120-139
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or
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80-90
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Yes
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No drug indicated
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Drug(s) for compelling indications‡
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Stage 1 hypertension
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140-159
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or
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90-99
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Yes
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Thiazide-type diuretic for most; may cinsider ACE inhibitor, ARB, beta-blocker, CCB or combination
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Drug(s) for compelling indications‡; Antihypertensive drugs (diurtic + ACE inhibitor, ARB, beta-blocker or CCB) as needed
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Stage 2 hypertension
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> 160
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or
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> 100
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Yes
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Two-drug combination† Thiazide-type (diurtic + ACE inhibitor, ARB, beta-blocker or CCB)
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Drug(s) for compelling indications‡Antihypertensive drugs (diurtic + ACE inhibitor, ARB, beta-blocker or CCB) as needed
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Abbreviations: BP, blood pressure; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CCB, calcium channel blocker
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Treatment determined by highest BP category. |
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Initial combined therapies should be used cautiously in those at risk for orthostatic hypertension. |
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Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mm Hg. |
The full JNC 7 report contains detailed recommendations for specific medications, possible combinations and drug class contraindications, as well as treatment recommendations for specific subgroups of patients in whom high blood pressure represents additional risk. In addition, the expected blood pressure reductions from various lifestyle and drug interventions are described. The report also suggests ways to improve the awareness of high blood pressure and its consequences among the general population.
For more information on the JNC 7 Report, click here.
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