OBJECTIVES

1. Discuss the pathophysiology and symptoms of Hypertension.

2. Describe methods for prevention, diagnosis and treatment of essential hypertension.

OUTLINE

ARTICLE #1: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood

ABSTRACT

The “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” provides anew guideline for hypertension prevention and management. The following are the report’s key messages:

• In persons older than 50 years, systolic blood pressure greater than 140 mmHg is a much more important cardiovascular disease (CVD) risk factor than diastolic blood pressure.

• The risk of CVD beginning at 115/75 mmHg doubles with each increment of 20/10 mmHg; individuals who are normotensive at age 55 have a 90 percent lifetime risk for developing hypertension.

• Individuals with a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg should be considered as prehypertensive and require 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 (angiotensin 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 mmHg, or <130/80 mmHg for patients with diabetes or chronic kidney disease).

• If blood pressure is >20/10 mmHg above goal blood pressure, consideration should be given to initiating therapy with two agents, one of which usually should be a thiazide-type diuretic.

• 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.

• In presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.

A. INTRODUCTION

B. CLASSIFICATION OF BLOOD PRESSURE

C. CARDIOVASCULAR DISEASE RISK

D. BENEFITS OF LOWERING BLOOD PRESSURE
E. BLOOD PRESSURE CONTROL RATES

F. ACCURATE BLOOD PRESSURE MEASUREMENT IN THE OFFICE

G. AMBULATORY BLOOD PRESSURE MONITORING
H. SELF MEASUREMENT OF BLOOD PRESSURE
I. PATIENT EVALUATION
J. TREATMENT