Deconstructing the JNC 7 – Part 1

JNC 7 is a document created by the United States National Heart, Lung and Blood Institute last August 2004. Its complete name is “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.” The report claims no remuneration was paid to any of the writers involved.

However, financial disclosures of the Executive Committee revealed that most of their individual researches were funded by different pharmaceutical companies. Financial information on other committees was not provided.

 

The complete report is claimed as an adjunct to other JNC 7 products which are listed below:

  • the JNC 7 Express
  • Facts About the DASH Eating Plan
  • Your Guide to Lowering High Blood Pressure
  • Reference Card from the JNC 7 for clinicians
  • Blood Pressure Wallet Card for patients
  • Palm application of the JNC 7 recommendations

The main objective of the JNC 7 is “to provide an evidence-based approach to the prevention and management of hypertension.”

The following conclusions can be drawn from this report:

  • systolic blood pressure (SBP) of >140 mmHg is a more important cardiovascular disease (CVD) risk factor than diastolic BP (DBP)
  • beginning at 115/75 mmHg, CVD risk doubles for each increment of 20/10 mmHg
  • those who are normotensive at 55 years of age will have a 90 percent lifetime risk of developing hypertension
  • prehypertensive individuals (SBP 120–139 mmHg or DBP 80–89 mmHg) require health promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD
  • for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes
  • this report delineates specific high-risk conditions, which are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta blockers, calcium channel blockers)
  • two or more antihypertensive medications will be required to achieve goal BP (<140/90 mmHg, or <130/80 mmHg for patients with diabetes and chronic kidney disease)
  • for patients whose BP is >20 mmHg above the SBP goal or 10 mmHg above the DBP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered
  • Regardless of therapy or care, hypertension will only be controlled if patients are motivated to stay on their treatment plan

JNC 7 is the current best practice used to treat hypertension. My aim is to provide a concise description from it. While most of the text presented here are lifted straight from the text in order to preserve the content, I will try to present my understanding of the subject matter. Also, I am devising a concept hypertensive clinic for primary care physicians. In order for me to achieve this, I must have a thorough knowledge about JNC 7. So bear with me as I go through this lengthy deconstruction.

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