The Seventh Report of the Joint National Committee on Prevention, Detection, Eva

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     "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 (55 years for men, >65 years for women)

    Family history of premature cardiovascular disease (men 1.5 mg/dL [>132.6 μmol/L] in men or >1.3 mg/dL [>114.9 μmol/L] in women)20 or (2) the presence of albuminuria (>300 mg/d or 200 mg albumin per gram of creatinine), therapeutic goals are to slow deterioration of renal function and prevent CVD. Hypertension appears in the majority of these patients and they should receive aggressive BP management, often with 3 or more drugs to reach target BP values of less than 130/80 mm Hg.59, 64

    The ACE inhibitors and ARBs have demonstrated favorable effects on the progression of diabetic and nondiabetic renal disease.55-59,64 A limited increase in serum creatinine of as much as 35% above baseline with ACE inhibitors or ARBs is acceptable and not a reason to withhold treatment unless hyperkalemia develops.65 With advanced renal disease (estimated glomerular filtration rate 55 years for men, >65 years for women)

    Family history of premature cardiovascular disease (men 1.5 mg/dL [>132.6 μmol/L] in men or >1.3 mg/dL [>114.9 μmol/L] in women)20 or (2) the presence of albuminuria (>300 mg/d or 200 mg albumin per gram of creatinine), therapeutic goals are to slow deterioration of renal function and prevent CVD. Hypertension appears in the majority of these patients and they should receive aggressive BP management, often with 3 or more drugs to reach target BP values of less than 130/80 mm Hg.59, 64

    The ACE inhibitors and ARBs have demonstrated favorable effects on the progression of diabetic and nondiabetic renal disease.55-59,64 A limited increase in serum creatinine of as much as 35% above baseline with ACE inhibitors or ARBs is acceptable and not a reason to withhold treatment unless hyperkalemia develops.65 With advanced renal disease (estimated glomerular filtration rate 102 cm [>40 in] in men or >89 cm [>35 in] in women), glucose intolerance (fasting glucose 110 mg/dL [6.1 mmol/L]), BP of at least 130/85 mm Hg, high triglycerides (150 mg/dL [1.70 mmol/L]), or low high-density lipoprotein cholesterol (