[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.161.155.6. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
May 1984

The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

Author Affiliations

American Academy of Family Physicians, American Academy of Ophthalmology, American Academy of Physician Assistants, American Association of Occupational Health Nurses, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Preventive Medicine, American Dental Association, American Dietetic Association, American Heart Association, American Hospital Association, American Medical Association, American Nurses' Association Inc, American Occupational Medical Association, American Optometric Association, American Osteopathic Association, American Pharmaceutical Association, American Podiatry Association, American Public Health Association, American Red Cross, American Society of Hospital Pharmacists, Citizens for the Treatment of High Blood Pressure, Committee on Hypertension in Minority Populations, National Black Nurses' Association Inc, National Heart, Lung, and Blood Institute, National Kidney Foundation, National Medical Association, National Optometric Association, and the Society for Nutrition Education.; Chairman University of Alabama School of Medicine Birmingham; Boston University School of Medicine; Hahnemann University School of Medicine Philadelphia; University of Minnesota Medical School Minneapolis; Alton Ochsner Medical Foundation New Orleans; Cleveland Clinic Foundation; The Johns Hopkins University School of Nursing Baltimore; School of Public Health University of North Carolina Chapel Hill; Southwestern Medical School University of Texas Dallas; Kaiser Foundation Hospital Los Angeles; Highgate Medical Group Williamsville, NY; New York Medical College Valhalla, NY; Osteopathic Medical Center of Philadelphia and Metropolitan Hospital Philadelphia; Washington University and St Louis Veterans Administration Hospital St Louis; Harlem Hospital Center New York; National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Md; National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Md; Kappa-Systems Inc Washington, DC; Kappa-Systems Inc Washington, DC

From the National High Blood Pressure Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md. A complete listing of participants is given at the end of this article.

Arch Intern Med. 1984;144(5):1045-1057. doi:10.1001/archinte.1984.00350170211032
Abstract

Since publication of the 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure,1 several events have occurred that affect successful management of hypertension: publication of major clinical trial results, introduction of new antihypertensive agents, evidence concerning effectiveness of nonpharmacologic treatment, and further analysis of the epidemiologic data-base relating BPs with the risk of premature morbidity and mortality. These events led the director of the National Heart, Lung, and Blood Institute (NHLBI), as chairman of the National High Blood Pressure Education Program Coordinating Committee, to establish a new Joint National Committee to revise earlier recommendations.

This report includes recommendations on the following topics: (1) screening and referral procedures, (2) classification according to BPs, (3) use of nonpharmacologic therapies, (4) revised stepped-care approach, (5) management of mild hypertension, (6) patient-professional interaction, and (7) management of BP in special groups, including blacks, children, and pregnant

References
1.
 The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1980;140:1280-1285.Article
2.
Kannel WB:  Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol 1976;37:269-282.Article
3.
Gifford RW Jr:  Isolated systolic hypertension in the elderly. JAMA 1982;247:781-785.Article
4.
Rowland M, Roberts J:  Blood Pressure Levels in Persons 6-74 Years: United States 1976-1980 , Advancedata . National Center for Health Statistics, Vital and Health Statistics No. 84. US Dept of Health and Human Services, Public Health Service, Oct 8, 1982.
5.
Mancia G, Grassi G, Pomidossi G, et al:  Effects of blood pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet 1983;2:695-697.Article
6.
Kirkendall WM, Feinleib M, Mark AL:  American Heart Association recommendations for human blood pressure determination by sphygmomanometer. Circulation 1980;62:1146-1155.
7.
Maxwell MH, Schroth PC, Waks AU, et al:  Error in blood pressure measurement due to incorrect cuff size in obese patients. Lancet 1982;2:33-36.Article
8.
Messerli FH, Frohlich ED:  High blood pressure: A common side effect of drugs, poisons, and food. Arch Intern Med 1979;139:682-687.Article
9.
Deeds SG, Bernheimer E, McCombs NJ, et al:  Patient behavior for blood pressure control: Guidelines for professionals. JAMA 1979;241: 2534-2537.Article
10.
Hill MN, Ball J, Williams R, et al:  Collaboration in high blood pressure control: Among professionals and with the patient. Ann Intern Med , in press.
11.
Current Research and Recommendations from the Task Force Reports on Therapy, Pregnancy, Obesity , US Dept of Health, Education, and Welfare publication (NIH) 79-1631. Report of the Hypertension Task Force, 1979, vol 9.
12.
Reisin E, Abel R, Modan M, et al:  Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertension patients. N Engl J Med 1978;298:1-6.Article
13.
MacGregor GA, Best F, Cam J, et al:  Double-blind randomized crossover trial of moderate sodium restriction in essential hypertension. Lancet 1982;1:351-355.Article
14.
Parijs J, Joosens JV, Van der Linden L, et al:  Moderate sodium restriction and diuretics in the treatment of hypertension. Am Heart J 1973;85:22-34.Article
15.
Klatsky AL:  The relationship of alcohol and the cardiovascular system. Ann Rev Nutr 1982;2:51-71.Article
16.
Iacono JM, Dougherty RM, Puska P:  Reduction of blood pressure associated with dietary polyunsaturated fat. Hypertension 1982;4( (suppl 3) ):34-42.Article
17.
 The Lipid Research Clinics Coronary Primary Prevention Trial Results. Lipid Research Clinics Program. JAMA 1984;251:351-374.Article
18.
Stamler J, Rhomberg P, Schoenberger JA, et al:  Multivariate analysis of the relationship of seven variables to blood pressure: Findings of the Chicago Heart Association Detection Project in Industry. J Chronic Dis 1975;28:527-548.Article
19.
Physician's Guide: How to Help Your Hypertensive Patients Stop Smoking , US Dept of Health and Human Services, publication (NIH) 83-1271. National High Blood Pressure Education Program, 1983.
20.
Patel C, Marmot MG, Terry DJ:  Controlled trial of biofeedback-aided behavioral methods in reducing mild hypertension. Br Med J 1981;282: 2005-2008.Article
21.
Engel BT, Glasgow MS, Garader KR:  Behavioral treatment of high blood pressure: III. Follow-up results and treatment recommendations. Psychosom Med 1983;45:23-29.Article
22.
 Effects of treatment on morbidity in hypertension: I. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. Veterans Administration Cooperative Study Group on Antihypertensive Agents. JAMA 1967;202:1028-1034.Article
23.
 Effects of treatment on morbidity in hypertension: II. Results in patients with diastolic blood pressures averaging 90 through 114 mm Hg. Veterans Administration Cooperative Study Group on Antihypertensive Agents. JAMA 1970;213:1143-1152.Article
24.
 The effect of treatment on mortality in 'mild' hypertension. Hypertension Detection and Follow-up Program Cooperative Group. N Engl J Med 1983;307:976-980.Article
25.
 The Australian Therapeutic Trial in Mild Hypertension: Report by the Management Committee. Lancet 1980;1:1261-1267.
26.
Smith WMcF:  Treatment of mild hypertension: Results of a ten-year intervention trial. US Public Health Service Hospitals Cooperative Study Group. Circulation Res 1977;40( (suppl 1) ):98-105.Article
27.
 Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA 1982;248:1465-1477.Article
28.
Hardy RJ, Hawkins CM:  The impact of selected indices of antihypertensive treatment on all-cause mortality. Am J Epidemiol 1983;117:566-574.
29.
Taguchi J, Freis ED:  Partial reduction of blood pressure and prevention of complications in hypertension. N Engl J Med 1974;291:329-331.Article
30.
 Beta-Blocker Heart Attack Trial (BHAT). Beta-Blocker Heart Attack Study Group. JAMA 1981;246:2073-2074.Article
31.
Hjalmarson A, Elmsfeldt D, Herlitz J, et al:  Effect on mortality of metoprolol in acute myocardial infarction. Lancet 1981;2:823-827.Article
32.
 Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. The Norwegian Multicenter Study Group. N Engl J Med 1981;304:801-807.Article
33.
Foster SB, Kousch D:  Adherence to therapy in hypertensive patients. Nurs Clin North Am 1981;16:331-341.
34.
Morisky DF, Levine DM, Green LW, et al:  Five-year blood pressure control and mortality following health education for hypertensive patients. Am J Public Health 1983;73:153-162.Article
35.
Levy RI, Moskowitz J:  Cardiovascular research: Decades of progress, a decade of promise. Science 1982;217:121-129.Article
36.
Blood Pressure Measurement by Non-physicians vis-à-vis Medical Practice . National Heart and Lung Institute Advisory Council. Position statement, Bethesda, Md, March 20, 1975.
37.
Moser M, Lunn J:  Comparative effects of pindolol and hydrochlorothiazide in black hypertensive patients. Angiology 1981;32:561-566.Article
38.
 The Report of the Task Force on Control of Blood Pressure in Children. Pediatrics 1977;69(pt 2):797-820.
39.
 Five-year findings of the hypertension detection and follow-up program: II. Mortality by race, sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242:2572-2577.Article
40.
National Heart Foundation of Australia Study:  Treatment of mild hypertension in the elderly: Report by the Management Committee. Med J Aust 1981;2:398-402.
×