[e-drug] JAMA Announcements

[E-drug <e-drug@healthnet.org>]

E-drug: JAMA Announcements
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The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure - the
JNC-7 Report - is now freely available online at http://jama.com . The
report will be published in the May 21 issue of JAMA. The guidelines
by the National Heart, Lung, and Blood Institute of the National
Institutes of Health provide evidence-based recommendations for
prevention, identification, and management of high blood pressure.

"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, -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.
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