JNC 7

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JNC 7

• The What, Why How of Hypertension

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What is JNC 7 ?

• Joint National Council on the Prevention,
  Detection , Evaluation Treatment of High Blood
  Pressure
• Under the NHBPEP which is under the NHLBI
• Composed of 39 organizations, professional,
  public voluntary organizations 7 federal
  agencies

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What are the most important functions of JNC 7 ?

• Increase awareness
• Prevention
• Treatment
• Control of Hypertension

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Trends in Awareness, Treatment Control of
Hypertension
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Why JNC 7 ?

• Publications of many new hypertension observation
  studies and clinical trials.
• The need for a new and clear, concise guidelines
  useful for clinicians.
• Simplify the classification of blood pressure.
• A clear recognition that JNC reports were not
  being used for maximum benefits.

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How will you classify my Hypertension ?
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Why is it Important to control my Blood Pressure ?

• Reduce stroke incidence by 35-40
• Reduce MI by 20-25
• Reduce Heart Failure by 50

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What is the proper way of taking Blood Pressure ?

• Instruments should be properly calibrated.
• Patients should be seated quietly for at least 5
  minutes. Seated on a chair with arms supported at
  heart level and feet planted on the floor.
• Appropriate cuff size. (encircling at least 80
  of area)
• At least two (2) measurements should be made.

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Self Measurements of Blood Pressure
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Three Objectives in Evaluating Patients with
Documented Hypertension.

• To assess the lifestyle identify other
  cardiovascular risk factors or concomitant
  disorders that may affect prognosis guide
  treatment.
• To reveal identifiable causes of high BP.
• To asses the presence or absence of target organ
  damage CVD.

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Cardiovascular Risk Factors
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Identifiable Causes of Hypertension
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Target Organ Damage
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Recommended Laboratory Test before initiating
Therapy.

• EKG
• Urinalysis
• Blood Glucose
• Hematocrit
• Serum Potassium
• Creatinine/GFR
• Calcium
• Lipid Profile

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Physical Examination Recommended

• BP measurement / includes contralateral arm
• Examination of optic disc
• Calculation of BMI (Wt (Kg)/sq (Ht(m))
• Auscultation ( carotid, abdominal femoral
  bruits)
• Palpation of thyroid gland
• Examination of Heart Lungs
• Examination of Abdomen
• Lower extremities
• Neurological assessment

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Goals in Therapy

• Reduction of Cardiovascular Renal Morbidity
  Mortality.
• 2. For gt50 year old, the focus is SBP control.
• 3.lt140/90 mmHg
• 4.lt130/80 mmHg for patients with hypertension, DM
  renal disease.

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Management Classification of Hypertension
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Life Style Modifications
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Pharmacologic Treatment
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Pharmacologic Treatment
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Clinical Trial Guideline basis for compelling
Indications for individual Drug Classes
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Algorithm for Treatment of Hypertension
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Algorithm for Treatment Hypertension
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Algorithm for Treatment Hypertension
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Algorithm for Treatment Hypertension
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Algorithm for Treatment Hypertension
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ACE, ARB Kidney Disease
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African Americans

• Prevalence, Severity Impact are increased in AA
• Their response to monotherapy with BBs, ACEI, ARB
  compared to diuretics CCB are reduced. This is
  eliminated with drug combination that include
  adequate doses of diuretics.
• ACEI induced angioedema occurs 2-4 times more in
  AA

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In Women In Pregnancy

• OCP may increase BP but not HRT
• Pregnant women should be followed more closely
  due to risk for both mother fetus
• ACE I ARB should be AVOIDED during pregnancy
  those who will likely to be pregnant
• Methyldopa, BBs, vasodilators are preferred for
  pregnancy

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Hypertensive Emergencies Urgencies

• Marked BP Elevation and ACUTE end Organ
  Damage e.g. encephalopathy, MI, Unstable Angina,
  pulmonary edema, eclampsia, stroke, head trauma,
  life threatening arterial bleeding or aortic
  dissection
• NEEDS Hospitalization !!!

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ADHERENCE TO REGIMENS

• Patient should be motivated
• Patients attitude greatly influenced by culture,
  beliefs previous experiences with the
  healthcare system
• Failure to titrate combine medications
• Clinicians Patients must agree with upon BP
  goals

• Patients may not understand the condition /or
  treatment
• Lack of patients involvement in the care plan
• Cost of medications
• All members of the healthcare team must work
  together to reinforce instructions to improve
  lifestyle BP control

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Resistant Hypertension

• Failure to reach BP Goal
• Adhering to full doses of appropriate 3 drug
  regimen that includes a diuretic
• Exclusion of identifiable cause of HTN

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Causes of Resistant Hypertension