Joint National Committee on High Blood Pressure

Introduction

2003 recommendations:

• any blood pressure (BP) over 115/75 mm Hg increases risk of death from heart disease & stroke
• this risk doubles with each 20/10 mm Hg increase in BP

4 categories of blood pressure

• normal: < 120/80 mm Hg
• prehypertension: 120-139/80-89 mm Hg
• stage 1 hypertension: 140-159/90-99 mm Hg
• stage 2 hypertension: 160/100 mm Hg or higher

Management

BP goals:

• < 140/90 mmg Hg for most patients
• ACP, JNC8 current recommendations: < 140/90 mmg Hg for patients with diabetes mellitus or chronic renal failure
• JNC8 recommends treatment of chronic hypertension with antihypertensive in patients >= 60 years of age when blood pressure is > 150/90 mm Hg
• JNC8 recommendations still < 140/90 for patients >= 60 with diabetes mellitus or chronic renal disease

* JNC7 recommendations: < 130/80 mmg Hg for patients with diabetes mellitus or chronic renal failure

initial antihypertensive options include ACE inhibitor, ARB, calcium channel blocker or thiazide diuretic (JNC8)

• Thiazide diuretics are recommended as 1st-line therapy of uncomplicated hypertension (JNC7)

Combination therapy is often needed to control BP

Life-style changes:

• weight loss
• exercise
• limiting alcohol
• smoking cessation

DASH diet recommended.

Avoid low-dose aspirin if BP not controlled to reduce risk of hemorrhagic stroke.

Additional terms

• blood pressure (BP)
• hypertension (HTN, high blood pressure, HBP)