of the Seventh Report
of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure:3
persons older than 50 years, systolic blood pressure greater than 140 mm Hg
is a much more important cardiovascular disease (CVD) risk factor than diastolic
risk of CVD beginning at 115/75 mm Hg doubles with each increment of 20/10
mm Hg; individuals who are normotensive at age 55 have a 90 percent lifetime
risk of developing hypertension.
- Individuals with a systolic blood pressure of 120-139 mm Hg or a diastolic
blood pressure of 80-89 mm Hg should be considered prehypertensive and
provided with instructions on health-promoting lifestyle modifications to prevent CVD.
- 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 (angiotensis
converting enzyme inhibitors, angiotensin receptor blockers, beta blockers,
calcium channel blockers).
- Most patients with hypertension will require two or more antihypertensive
medications to achieve goal blood pressure (<140/90 mm Hg, or <130/80 mm Hg
for patients with diabetes or chronic kidney disease).
blood pressure is >20/10 mm Hg above goal blood pressure, consideration
should be given to initiating therapy with two agents, one of which usually
should be a thiazide-type diuretic
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.
presenting these guidelines, the committee recognizes that the responsible
physician’s judgment remains paramount.