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Information about high blood pressure
Onsite information is accessed via the buttons on the left. Check out the Blood Pressure Association www.bpassoc.org.uk
Beta-blockers no longer best for blood pressure, say experts 28/6/06
Up to 2 million people with high blood pressure should switch from beta-blockers to a more modern drug, the National Institute for Clinical Excellence has announced. The group advised that the vast majority of patients should switch to a marginally more expensive drug to cut their risk of diabetes and halve their risk of a stroke. Research recently revealed that switching from beta-blockers to newer drugs, such as ACE inhibitors or Calcium Channel Blockers, not only reduced the risk of a heart attack by 20 per cent, but also halved the risk of a stroke.
New Hypertension Guidelines in the US: JNC 7
The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure (JNC 7) incorporates evidence published since JNC 6 was
issued in 1997. JNC 7 simplifies the classification of blood-pressure
levels and outlines how to use this new classification scheme
for hypertension prevention and management.
BP Scheme for Adults (in mm Hg)
 | Normal: systolic BP <120 and diastolic BP <80
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| Prehypertension: SBP 120-139 or DBP 80-89
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| Stage 1 hypertension: SBP 140-159 or DBP 90-99
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| Stage 2 hypertension: SBP > 160 or DBP > 100
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The Essential Points of JNC 7:
| For patients age 50 or older, elevated SBP is a stronger
cardiovascular risk factor than elevated DBP.
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| Within the BP range of 115/75 mm Hg to 185/115
mm Hg, each increment of 20/10 mm Hg doubles
cardiovascular risk.
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| Prehypertension warrants management with
lifestyle modification (e.g., low-salt diet, regular physical
activity).
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| For patients with hypertension, the basic BP-control
target is <140/<90 mm Hg, but the target is <130/<80
mm Hg for patients with diabetes or renal disease.
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| Thiazide diuretics are recommended as initial
therapy for uncomplicated hypertension, either alone or in
combination with other agents. This recommendation is supported by
an accompanying meta-analysis of 42 clinical trials (192,478
participants) done by researchers who were independent of the
guideline authors; the meta-analysis showed that low-dose diuretics
were significantly better than placebo for preventing coronary
heart disease, heart failure, stroke, and all-cause mortality. No
other drug class was significantly better than low-dose diuretics
for preventing these outcomes.
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| Most hypertensive patients will require 2 or more
medications to achieve BP goals. When initial BP is more than 20/10
mm Hg above goal, clinicians should consider initiating therapy
with 2 agents, usually including a diuretic.
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| The authors emphasize the importance of the
physician-patient relationship and patient motivation in
fostering treatment adherence. |
Comment by Thomas L. Schwenk, MD
Published in Journal Watch May 30, 2003
: Using JNC 7 as a
point of departure, an editorialist argues that hypertension control
will improve only with substantial changes in the delivery of
chronic-disease care and in how the public views lifestyle changes.
Hypertension is an easily diagnosed and (potentially) easily treated
problem. Nevertheless, despite more than 30 years of guidelines
exhorting physicians and physicians exhorting patients, primary care
physician behavior and patient lifestyle modification have not
changed enough to result in appropriate levels of detection and
control of hypertension.
Source:
Chobanian AV et al. The seventh report
of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003 May
21; 289:2560-72.
[Original article][Medline
abstract][Download
citation]
Psaty BM et al. Health outcomes
associated with various antihypertensive therapies used as first-line agents: A
network meta-analysis. JAMA 2003 May 21; 289:2534-44.
[Original article][Medline
abstract][Download
citation]
Kottke TE et al. JNC 7 -- It's more
than high blood pressure. JAMA 2003 May 21; 289:2573-5.
[Original article][Medline
abstract][Download
citation]
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The Minster Practice, Lichfield
