Guest guest Posted October 9, 2011 Report Share Posted October 9, 2011 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 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 diabetes 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. Here is what I get from this. First B/P over 115/75 increases fisk of getting high B/P next systolic B/P over 120 and less then 140 or diastolic B/P over 80 and less then 90 is prehypertensive and require health-promoting lifestyle modifications to prevent CVD. Systolic B/P of 140 or more or diastolic B/P of 90 or more is Dx of high B/P Treatment for high B/P is to get it to 140/90 if you don't have diabetes and 130/80 if you do. Without DX of high B/P normal B/P is systolic less then 120 and diastolic less then 80 With DX any thing less then Systolic B/P of 140 or or diastolic B/P of 90 is new normal. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2011 Report Share Posted October 9, 2011 JNC-7 is fast becoming a history lesson. JNC-8 (or as Dr. G. calls it JNC-LATE) should have already been released and is now due 1Q12. If you want to review " recommended BP " , I have a couple of suggestions since I have spent a lot of time researching it as it relates to DM. To start with there are two items you should consider and review, J-curve effect and JNC-8 pre-views. A good place to learn about the J-curve effect is: http://www.medscape.com/viewarticle/712113_print Here you will learn that there is an adverse outcome as BP gets too low. The second place I suggest is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150713/pdf/JZUSB12-0611.pdf This is an article, " Target blood pressure in diabetes patients with hypertension—What is the accumulated evidence in 2011? " By M. Nilsson and in my opinion gives a good idea where JNC-8 is headed. (You might have to take a " leap of faith " that the Swedes know what they are talking about!) I have purposely not tried to enter my opinions and biases as there are still many professionals with opinions! I will say that it appears the std. for PTNs w/DM is going up, I'll let you know if my PCP agrees after the 24th! (If you want to check this out look at the ACCORD Trial Study.) - 65 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > 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 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 diabetes 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. > > > Here is what I get from this. First B/P over 115/75 increases fisk of getting high B/P > > next systolic B/P over 120 and less then 140 or diastolic B/P over 80 and less then 90 > is prehypertensive and require health-promoting lifestyle modifications to prevent CVD. > > Systolic B/P of 140 or more or diastolic B/P of 90 or more is Dx of high B/P > > Treatment for high B/P is to get it to 140/90 if you don't have diabetes and 130/80 if > you do. > > Without DX of high B/P normal B/P is systolic less then 120 and diastolic less then 80 > > With DX any thing less then Systolic B/P of 140 or or diastolic B/P of 90 is new normal. > Quote Link to comment Share on other sites More sharing options...
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