JNC 7 Urges Aggressive Management of Hypertension
Absent from the much-anticipated report is the risk-stratification system introduced by the JNCs sixth report in 1997 and the term high-normal blood pressure.
The JNC, part of the National High Blood Pressure Education Program coordinated by the National Heart, Lung, and Blood Institute, customarily issues a report every four years or so, making the seventh report due in 2001. But the results of the large-scale Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were expected to be released the next year; an early finding, announced in March 2000, was the poor result from treatment with the alpha1-adrenergic receptor blocker used in the study. In December 2002, ALLHATs final results were announced: a traditional diuretic outperformed both an angiotensin-converting-enzyme (ACE) inhibitor and a calcium-channel blocker.
The algorithm for treatment of hypertension appears more streamlined in JNC 7 (see figure) than in the previous report. A thiazide diuretic is recommended for most patients with a systolic blood pressure of 140159 mm Hg or a diastolic value of 9099 mm Hg who do not have a compelling indication, such as diabetes mellitus or renal insufficiency. Combination therapy should be used for most patients with a systolic blood pressure of >160 mm Hg or a diastolic value of >100 mm Hg but without a compelling indication. For patients with hypertension and a compelling indication, one or more of the following drug types should be used: ACE inhibitor, angiotensin-receptor blocker, beta-blocker, calcium-channel blocker, and diuretic.
The term prehypertension is used to describe the condition between normal blood pressure and hypertension. Drug treatment of patients with prehypertension is not recommended unless they have a compelling indication. The maximum values for normal blood pressure are a systolic pressure of 119 mm Hg and a diastolic pressure of 79 mm Hg.
The more comprehensive version of JNC 7 will be published separately this year.
- National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7 express. Bethesda, MD: U.S. Department of Health and Human Services, 2003; NIH publication no. 03-5233.
Strategies for Controlling Blood Pressure
One of the best ways to control blood pressure is to provide patient management by individuals who take a very keen interest in achieving [blood pressure] control in the population, said Barry L. Carter, a professor at the University of Iowa College of Pharmacy in Iowa City and ASHPs representative to the National High Blood Pressure Education Program. Either pharmacist- or nurse-managed clinics have been perhaps the most effective strategies to [control blood pressure] because those providers are immersed in the whole notion of getting those patients to a lower blood pressure
The second most successful strategy is physician report cards, he said, noting that they are more effective when provided as a quality assurance tool within a medical practice than as a scorecard by an outside organization.
Carter said academic detailing is somewhat effective, with success tied to whether the person is part of the medical practice.