Oct 12, 2015 diagnosing and treating hypertension plays an important role in minimising the risk of cardiovascular disease and stroke. Algorithm for treatment of hypertension reference card from the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal jul 19, 2018 the main difference between these two recommendations is the definition of arterial hypertension. Resistant hypertension rh is defined as blood pressure above a goal despite adherence to at least 3 optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Referral to a hypertension specialist may be indicated for patients in whom goal bp cannot be attained using the above strategy or for the management of complicated needed. Detection, evaluation, and treatment of high blood pressure jnc 7. Hypertension guidelines evidencebased treatments for maintaining blood pressure control. The american heart association requests that this document be cited as follows.
They should be essential in everyday clinical decision making. Does the change of hypertension guidelines actually affect. The range of blood pressures between 12080mmhg and 14090mmhg will likely remain a battleground of discussion. Early and accurate diagnosis of hypertension, as well as regular monitoring, is essential to meet treatment targets. This increases the risk for developing several dangerous health conditions including heart attack, stroke, chronic heart failure chf, and kidney disease. Evaluation, and treatment of high blood pressure jnc 7 highlight several important issues, including the following 1. Since jnc 6 1997, important new evidence has emerged from observational and clinical trials of hypertension management. The 2017 guideline is an update of the seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure jnc 7, published in 2003.
European society of cardiology scientific document group. Revisiting the jnc 7 recommendations jeffery martin, m. The seventh report of the joint national committee on. Strengths and limitations of the jnc 8 hypertension. Apart from the definition of prehypertension and the advice to begin therapy with diuretics in most patients with stage 1 hypertension, jnc 7 shares several positions with the hypertension guidelines recently released by the european society of cardiology and european society of hypertension. Jnc 8 guidelines for the management of hypertension in adults. The eighth joint national committee jnc 8 guidelines on hypertension have generated great interest among physicians. Jnc 1 was eight pages and described 24 drugs available for use. National high blood pressure education program coordinating committee of the national heart, lung, and blood institute purpose. Jun, 2003 unlike jnc 6, jnc 7 does not advocate global risk assessment to guide therapy, but treatment still should be tailored to an individuals risk profile. The book contains 171 short chapters by distinguished experts that cover every aspect of hypertension and its pathogenesis, epidemiology, impact, and management. Jnc 8 hypertension guideline algorithm initial drugs of.
In addition, roughly half of hypertensive individuals do not have adequate blood pressure control. Tumor necrosis factoralpha antagonist etanercept decreases blood pressure and protects the kidney in a mouse model of systemic lupus erythematosus. The jnc 7 report recommended a blood pressure goal of 85 mm hg for patients with diabetes. Hypertension, society, and public policy european heart. The jnc 7 report 1 recommended a blood pressure goal of 85 mm hg for patients with diabetes. In contrast, jnc 8 focuses narrowly on drug treatment. The jnc 8 panel confirms that the 14090 mmhg definition for hypertension from the jnc 7 report remains the standard for diagnosis for individuals who do not have additional comorbidities. The seventh report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure jnc 7 has recently came. Hypertension the new guidelines the greatest danger to a man with high blood pressure lies in its discovery, because some fool is. We crossclassified men and women separately according to their jnc vi blood pressure stages and risk groups. Recent estimates are that 874 million adults worldwide have an sbp of 140 mm hg or higher. Refined and updated, the most recent versions are the us seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7, 7 and the european guidelines for the management of arterial hypertension. Esc clinical practice guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on arterial hypertension.
The diagnosis of hypertension must be accompanied by an appropriate family and clinical history, documented elevated recordings of systolic andor diastolic blood pressure and a report of the physical examination. Hypertension 1 update, jnc8 and beyond tara shrout, david w rudy2 and michael t piascik3. Treatment of high blood pressure jnc 7 was based on 4 factors. Reference card from the seventh report of the joint national. This approach is now generally accepted and had already been integrated into the 2003 and 2007 eshesc guidelines for the management of arterial hypertension. Common questions about the initial management of hypertension.
None of the larger controlled studies 25 of hypertension in patients with diabetes mellitus, however, achieved a mean systolic blood pressure of less than 140 mm hg, despite intensive treatment. Jnc 8 hypertension guideline algorithm lifestyle changes. Seventh report of the joint national committee on the. Pdf the seventh report of the joint national committee on. Hypertension affects 29% us adult population estimated 72 million people, with a prevalence of 65% in persons older than 60 yrs, 1 in 3 adults hypertension disproportionately affects the african american community with over 45% aa males and 46% aa females affected by high blood pressure compared to a national rate of 33%. Jnc 8 and more hypertension guidelines from the eighth joint national committee jnc 8 are finally here. In persons older than 50, systolic blood pressure bp of more than 140 mm hg is a much more important cardiovascular. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure provides a new guideline for hypertension prevention and management.
The jnc 8 writing group did not address the definition of htn that was defined in the jnc 7 guideline. Of note, the top ranking 1 to 4 articles listed by hypertension had similar order of rank as in our t100. The 2017 guideline on management of high blood pressure in adults. May 30, 2003 using jnc 7 as a point of departure, an editorialist argues that hypertension control will improve only with substantial changes in the delivery of chronicdisease care and in how the public views lifestyle changes. Jul 11, 2018 furthermore, on the basis of treatment patterns and current guidelines, 8. The vision of jnc 7 is not only to synthesize this evidence, but also specifically to simplify classification of blood. Arterial stiffness as a cause of resistant hypertension. Hypertension is an easily diagnosed and potentially easily treated problem.
Blood pressure jnc7 provides additional scien tific evidence to. In the 2003 guidelines, classification of hypertension was similar to that in jnc 7, and indications for ambulatory blood pressure monitoring and measurement of home blood pressure were suggested. Dash diet dietary approaches to stop hypertension as effective as one medication jnc 7 summary joint national commission 7th report pdf file on website 50 page document other jnc 7 resources software for use with palm and pocket pc jnc 7 reference card other resources chronic kidney disease information gfr calculator. More than twothirds of individuals after age 65 years suffer from hypertension according to the seventh report of the joint national committee jnc 7. Between 1977 and 2003, under the direction of the national institutes of health nih, the joint national committee on detection, evaluation, and treatment of high blood pressure jnc issued 7 reports. The jnc 7 hypertension guidelinesthe jnc 7 hypertension.
Guidelinerecommended antihypertensive medication mostly remained the same in general population, patients with diabetes and chronic kidney failure. Tumor necrosis factoralpha antagonist etanercept decreases blood pressure and protects the kidney in. Boston university school of medicine, boston, ma executive committee george l. Escesh arterial hypertension management of guidelines. The main difference between these two recommendations is the definition of arterial hypertension.
Hypertension and risk stratification hypertension research. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure resource description. However, individuals with numerous disease markers table iii or limited evidence of early target organ damage such as left ventricular. Jnc 7 used cut off of 140 andor 90 mmhg for systolic and diastolic bp, respectively. In subsequent years, a series of joint national committee jnc bp guidelines were. The seventh report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure jnc 7, coordinated by the national heart, lung, and blood institute, has recently came to light in a short version 1 and a more complete version will be published soon. Arterial bp is the pressure in the blood vessel, specifically the. The joint national committee on prevention, detection, evaluation, and treatment of high blood pressure recently released its seventh report jnc 7. Individuals with ash stage 2 hypertension jnc 7 stage 1 hypertension frequently have sustained resting bp levels 140. While we were waiting for jnc 8, the american society of hypertension ash in collaboration with the international society of hypertension released their own expert opinion piece aimed at prescribers.
The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure iii chair aram v. Detection, evaluation, and treatment of high blood pressure jnc 7 evaluation classification of blood pressure bp category sbp mmhg dbp mmhg normal 89 hypertension, stage 1 140159 or 9099 hypertension, stage 2. Methods the decision to appoint a committee for the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 was based on 4 factors. High blood pressure is a common condition, afflicting 29% of the adult population of.
Under the managem ent of the accaha task force, a prevention subcommittee was appointed to help guide development of the suite of guidelines on prevention of cardiovascular disease cvd. Detection, evaluation, and treatment of high blood pressure. What is the evidence base for diagnosing hypertension and for. These guidelines differ from those published in 2003 the jnc 7. Now in its thoroughly updated fourth edition, the hypertension primer is a comprehensive, readable source of stateoftheart scientific and clinical information on hypertension. Jnc 7 sets a novel approach to the management of hypertension with emphasis on patients classified as prehypertensives. The concept is based on the fact that only a small fraction of the hypertensive population has an elevation of bp alone, with the majority exhibiting additional cv risk factors.
These 2018 esc esh guidelines for the management of arterial hypertension are designed for adults with hypertension, that is aged at least 18 years. The national high blood pressure education program nhbpep, coordinated by the national heart, lung, and blood institute nhlbi, has released its longawaited joint national committee jnc 7 report. Initial evaluation of hypertension pointofcare guides. Compared to 2003 guidelines, classification of hypertension changed only slightly in 2007, with no subsequent change in 20. Crossclassification of jnc vi blood pressure stages and risk. Elevated blood pressure is associated with an increased risk of heart failure, myocardial infarction. Guidelines represent consensus statements by expert panels, and the process of guideline development has inherent vulnerabilities. None of the larger controlled studies of hypertension in patients with diabetes mellitus, however, achieved a mean systolic blood pressure of less than 140 mm hg, despite intensive treatment. Society of cardiology guidelines for the management of arterial hypertension. As an editorialist notes, despite an extensive history of jnc guidelines, hypertension awareness and control in the u. The society established the writing group of the american society of hypertension wgash to formulate the new definition.
These guidelines differ from those published in 2003 the jnc 7in the. Epidemiologic and clinical perspectives janet h southerland, dds, mph, phd. The prevalence of hypertension is lower in women compared with men until about the hipertension arterial jnc 7 decade, but is higher later in life. Aging, arterial stiffness and hypertension pubmed central pmc. Jnc 8 guidelines on htn, evidence from clinical trials indicate that. Such individuals are at increased risk for the development of hypertension and, therefore, should be encouraged to undergo lifestyle modification as well as frequent monitoring. Causes of secondary hypertension with clinical indications and diagnostic screening tests 1 of. Detection, evaluation and treatment of high blood pressure jnc 7 and is a comprehensive resource for the clinical and public health practice communities. The global prevalence of hypertension is high, and among nonpregnant adults in the united states, treatment of hypertension is the most common reason for office visits and for the use of chronic prescription medications. In the jnc 7 guidelines, the 7 categories of blood pres. Mar 15, 2004 the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure recently released its seventh report jnc 7. Seventh report of the joint national committee on prevention.
These are the sources and citations used to research hypertension. Reference card from the seventh report of the joint. This guideline was a key pcor finding disseminated to. Hypertension medicine bibliographies cite this for me. Since the publication of the sixth report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure jnc vi released in 1997,1 many largescale clinical trials have been published. In recent years, metabolic syndrome and hypertension are increasingly seen in the middleaged and young populations. Hypertension is the most common chronic condition treated by family physicians. Individuals with ash stage 2 hypertension jnc 7 stage 1 hypertension frequently have sustained resting bp levels. Guidelinerecommended antihypertensive medication mostly remained the same in. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7. In may 2005, just 2 years after the publication of the jnc 7 guidelines, the american society of hypertension proposed a new definition of hypertension. The treatment of arterial hypertension should start before significant cardiovascular damage develops and is usually lifelong.
Jnc 7, the predecessor of this guideline, was a comprehensive document that covered not only hypertension treatment, but also definitions of hypertension, issues in bp measurement, public health perspectives, lifestyle modification, and special situations in hypertension management. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 recommends that thiazidetype diuretics should be prescribed as initial therapy for most patients with hypertension. Thus, although the jnc 7 guidelines seem to provide a reasonable goal, there is. Kdoqi clinical practice guidelines for chronic kidney disease. Smoking cessation control blood glucose and lipids diet eat healthy i. The jnc 7 hypertension guidelinesreply jama jama network. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high. Pdf the seventh report of the joint national committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The purpose of the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure jnc 7 is to provide an evidencebased approach to the prevention and management of hypertension.
By designating fewer categories, jnc 7 simplifies the classification of bp for adults. High blood pressure can also have damaging effects to the brain, specifically it can cause an aneurysm or stoke. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. On the other hand, accaha reduced these cutoff values on andor 80 mmhg. Dec 05, 2017 hypertension is a leading risk factor for mortality and disability. The seventh report of the joint national committee on the.
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