JNC 7: Hypertension Treatment Algorithm

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  • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) issued recommendations for the management of hypertension (identified as a major risk factor for CHD by the NCEP ATP III guidelines). Treatment is determined by the highest BP category obtained as the average of two or more accurate in-office BP measurements on each of two or more visits. Key messages from the report include: In individuals >50 years of age, SBP >140 mm Hg is a “much more important” CVD risk factor than DBP.
  • Individuals with SBP 120–139 mm Hg or DBP 80–89 mm Hg should be considered prehypertensive, reflecting an increased risk of future hypertension and requiring health-promoting lifestyle modifications to prevent CVD.
  • Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or in combination with drugs from other classes. Certain high-risk conditions, including MI, diabetes, and chronic kidney disease, are compelling indications for the initial use of other antihypertensive drug classes (ie, ARB, ACEI, beta-blocker, CCB). The compelling indication is managed parallel with the BP.
  • Most patients with hypertension will require two or more antihypertensive drugs to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or CKD).
  • If BP is >20/10 mm Hg above goal BP, consider initiating therapy with two agents, one of which should usually be a thiazide-type diuretic.
  • A physician’s judgment remains paramount to these guidelines.

Chobanian AV et al. JAMA. 289;2560-2572.