Deconstructing JNC 7 – Part 2

Important points from the Lifetime risk of Hypertension section:

The prevalence of hypertension increases with advancing age to the point where more than half of people 60–69 years of age and approximately three-fourths of those 70 years of age and older are affected.

Framingham Heart Study investigators recently reported the lifetime risk of hypertension to be approximately 90 percent for men and women who were nonhypertensive at 55 or 65 years and survived to age 80–85. Even after adjusting for competing mortality, the remaining lifetime risks of hypertension were 86–90 percent in women and 81–83 percent in men.

The impressive increase of BP to hypertensive levels with age is also illustrated by data indicating that the 4-year rates of progression to hypertension are 50 percent for those 65 years and older with BP in the 130–139/85–89 mmHg range and 26 percent for those with BP between 120–129/80–84 mmHg range.

JNC 7 shows figures that conclude that about 90% of the current population is at risk of hypertension, whether the initial BP at presentation at your clinic is normal or not. This is why it is important to monitor blood pressure even if your patient does not carry risk factors. The figures presented in the JNC are taken from adult patients and are largely from American studies.

The following figures are also important:

For every 20 mmHg systolic or 10 mmHg diastolic increase in BP, there is a doubling of mortality from both IHD and stroke.

These images look the same as both shows that Ischemic Heart Disease and Stroke risk doubles as the BP goes up. This is important to explain to your patient. Most of the uncompliance with my patients are not based on how much the meds cost but rather on the ignorance of the complications of a chronic high BP.

Longitudinal data obtained from the Framingham Heart Study have indicated that BP values between 130–139/85–89 mmHg are associated with a more than twofold increase in relative risk from cardiovascular disease (CVD) as compared with those with BP levels below 120/80 mmHg.

The preceeding figure charted cardiovascular risk in patients with normal BP on presentation. The blue line shows pre-hypertensive levels on follow-up and the rest are those for 120 and below. This shows that failing to follow-up prehypertensive patients and not aiming for an optimum of SBP below 120 can be catastrophic.

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