Update in Nephrology and Hypertension

Clinical Hypertension

Guidelines Advised Physicians on the Care of Patients with High Blood Pressure

The Joint National Committee (JNC) 7 report aimed to provide a current and succinct guide to improving awareness, prevention, treatment, and control of hypertension. In particular, the JNC 7 report offered 2 major changes from the JNC 6 report. First, the committee reclassified blood pressure, and second, it revised the risk stratification treatment recommendations.

The committee defined a normal blood pressure as less than 120/80 mm Hg, a level that previous committees called “optimal.” The committee classified levels that earlier committees called normal and high-normal as prehypertension. They selected the term prehypertension as a wake-up call for physicians and patients to recognize that cardiovascular risk increases continuously with increasing blood pressure. The report also folded stage 3 hypertension into stage 2 hypertension because the committee recognized that patients with blood pressure greater than 160/100 mm Hg required at least 2 medications for control. The committee wanted to encourage physicians to give patients with stage 2 hypertension combination therapy rather than single-drug therapy and then slowly increase the doses.

For patients with prehypertension, every 20/10 mm Hg–increase in blood pressure over the entire range of blood pressure doubles the risk for cardiovascular events. Among patients older than 50 years of age, a systolic blood pressure greater than 140 mm Hg is a greater cardiovascular risk factor than diastolic blood pressure.

The JNC 7 also simplified risk stratification and treatment recommendations. It proposed 3 classes for pharmacologic therapy based on whether patients have a compelling indication for a …