May 15, 2003 |
New recommendations for tighter control of high blood pressure may drastically reduce the number of individuals who die each year from hypertension-related illnesses, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII).
From American Heart Association:New high blood pressure guidelines say start early, treat aggressively
WASHINGTON, May 14 ? New recommendations for tighter control of high blood pressure may drastically reduce the number of individuals who die each year from hypertension-related illnesses, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII).
A summary report is published in today’s JAMA Express, and the full report will be published this summer in Hypertension: Journal of the American Heart Association.
High blood pressure (hypertension) affects about 50 million Americans and 1 billion people worldwide, according to the report. “The relationship between blood pressure and risk of cardiovascular disease events is continuous, consistent, and independent of other risk factors,” the committee writes. “The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke, and kidney disease.”
The National High Blood Pressure Education Program Coordinating Committee ? a coalition of 39 major professional, public and voluntary organizations and seven federal agencies ? issued the JNC VII guidelines.
The new guidelines highlight four basic strategies:
Pay attention to blood pressure before it’s high.
The new classification ? “prehypertension” ? describes people with blood pressures between 120-139 millimeters of mercury (mm Hg) systolic (the top number in a blood pressure reading) or 80-89 mm Hg diastolic (bottom number).
“We have thought of blood pressures under 140/90 mm Hg as being okay,” says Daniel W. Jones, M.D., the American Heart Association representative on the JNC VII committee and the incoming dean of the school of medicine at the University of Mississippi Medical Center in Jackson. Jones is currently the executive associate dean. “The evidence is now clear that those in the prehypertension range are at higher risk than those with lower blood pressures and are much more likely to move into the hypertension range where medication is required. But lifestyle changes can help those with prehypertension.”
The new prehypertension category focuses physician, patient and public attention on blood pressure in these ranges to motivate them to adopt health-promoting lifestyles.
“Before JNC VII, the definitions were more complicated and perhaps misleading. For example, the older terms “high normal” and “borderline” high blood pressure suggested to some a lack of importance,” says Claude Lenfant, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI) and an author of an editorial that accompanies the report that will be published in Hypertension.
In people over age 50, systolic pressure is more important than diastolic.
The guidelines say systolic pressure of 140 mm Hg or greater in that age group should be treated regardless of the diastolic blood pressure level. For patients with stage one hypertension (systolic pressure of 140-159 mm Hg) and additional cardiovascular risk factors, a sustained 12 mm Hg reduction in systolic pressure for more than 10 years will prevent about one death for every 11 patients.
“Patients and clinicians should not be lulled into a false sense of security because of a ‘normal’ diastolic blood pressure. Focused treatment at this age can mean great benefits later in life in the form of less cardiovascular and kidney disease, which have a huge impact on quality of life,” Jones stresses.
Two (or more) drugs are better than one for most patients.
Most hypertensive patients will require two or more antihypertensive medications to achieve goal blood pressure (less than 140/90 mm Hg, or less than 130/80 mm Hg for those with diabetes or kidney disease). Current rates of blood pressure control are still far below the Healthy People 2010 goal, which is to have 50 percent of Americans reach the blood pressures control goal of 140/90 mm Hg or less.
“Using more than one drug to treat most patients will be key to improving blood pressure control rates. Patients and physicians need to begin the drug treatment process with an open mind to using as much medication as necessary to achieve goal blood pressure,” Jones says.
For most patients, controlling high systolic pressure has been considerably more difficult than controlling diastolic hypertension. Recent clinical trials have shown that two or more antihypertensive drugs may be needed to achieve optimal pressure.
Build trusting clinician/patient relationships that motivate patients to be healthy.
The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Patient attitudes are greatly influenced by cultural backgrounds, beliefs and previous experiences with the healthcare system. A patient-centered strategy to achieve the goal and an estimated time for reaching the goal are important, according to the report.
“We expect our school teachers to be motivators as well as educators. We should expect no less from healthcare professionals,” Jones says.
NR03 ?1079 (JNC VII)