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Special Communication
Clinician's Corner
May 21, 2003

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report

Author Affiliations

Author Affiliations: Department of Medicine, Boston University School of Medicine, Boston, Mass (Dr Chobanian); Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill (Drs Bakris and Black); Veterans Affairs Medical Center, Departments of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis (Dr Cushman); Department of Family Medicine, University of Michigan, Ann Arbor (Dr Green); Department of Medicine and Pharmacology, State University of New York at Buffalo School of Medicine, Buffalo (Dr Izzo); Department of Medicine and Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson (Dr Jones); Department of Medicine, University of Miami School of Medicine, Miami, Fla (Dr Materson); Department of Medicine, Physiology, and Biophysics, Division of Cardiovascular Disease, University of Alabama at Birmingham (Dr Oparil); Departments of Medicine, University Hospitals of Cleveland and the Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio (Dr Wright); and National High Blood Pressure Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Roccella).

JAMA. 2003;289(19):2560-2571. doi:10.1001/jama.289.19.2560

"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 following are the key messages

(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.