Following is the summary of the 73 page document from the JNC VI released in 1997. They are for patients 18 years of age or older. On the right side is the comparison and differences for the Latest JNC 7 of 2003.

JNC 6 1997

Recommendations for patient:

  1. Rest for 5 minutes
  2. No smoking/caffeine for 30 min prior to measuring BP
  3. Keep Arm at heart level in sitting position

Recommendations for Doctor:

  1. Doctor to use appropriate sized cuff (Bladder encircling > 80% of upper arm)
  2. Mercury sphygmomanometer is best
  3. Use 2 or more readings separated by at least 2 minutes. JNC 7 says 5 minutes.

Blood Pressure Stages

These have changed in JNC7 so look in other column.

Goals of BP to be as follows

  1. 140/90 mmHg in patients (without end organ damage or diabetes or renal damage)
  2. 130/85 mmHg for patients with Diabetes(changed to 130/80 in JNC 7)
  3. 125/75 mmHg for patients with renal insufficiency WITH proteinuria >1Gm/24 hrs (changed to 130/80 in JNC 7)

How to start treating

(Unless patient has Target organ damage or DM - in which case there should be drug therapy straight away  - even for those with high normal BP) ,

  1. Initiate therapy with Lifestyle interventions which are as follows 
  2. Weight loss if weight is more than 10% over the Ideal body Weight.
  3. Low sodium diet.
  4. 30-45 minutes aerobic exercise
  5. Maintain Potassium intake >90mmol/day
  6. Maintain adequate calcium and magnesium intake (Magnesium got deleted in JNC 7)
  7. Although quitting smoking may not make a significant change in BP, quitting will prevent rapid end organ damage.
  8. Add pharmacologic therapy if lifestyle change not effective even after 6 months.
  9. Start with Diuretic or beta blocker unless (Evidence is there that White men may benefit more if initial Rx is ACE  in an Australian trial per JNC 7) compelling reason to use another agent
  10. Try low doses of drugs.
  11. If inadequate control, add another class of drugs. Always consider non compliance to be a cause of inadequate control.
  12. Keep treatment affordable and simple
  13. Use combination tablets whenever possible

 

Compelling indications in JNC 6 - 1997

  1. DM type 1 : ACE Inhibitor if proteinuria present. Avoid Calcium channel blocker (b/c may increase proteinuria)
  2. Heart Failure : Start with ACE I or diuretic
  3. MI : Beta blocker. ACE I if LV dysfunction after MI
  4. Isolated Systolic hypertension : Diuretics or CCBs (Long acting CCBs - DHP type)
 JNC 7 2003

The additions or differences will be placed here.

Ideal BP implied by the report is 115/75 or lower.

Blood Pressure Stages

  1. Normal  is < 120/80.
  2. Pre-hypertension = 120-139/80-89
  3. hypertension stage 1 = 140-156/90-99
  4. hypertension stage 2 = >160/100

Note that the SBP is in 20 mmHg increments and DBP in 10 mmHg increments.

I could not find the complete guidelines so have had to rely on the summary of 52 pages.

Systolic BP is more important in people over 50.

Risk of CVD doubles with every increment of BP by 20/10 mmHg.

90% of people will eventually develop  HTN.

Thiazide diuretics must be tried in treatment unless contraindicated. If Initial BP higher than goal by 20/10 then consider starting with 2 drugs (Use agents combined in one pill).

Lifestyle modifications to manage hypertension

Modification Recommendation Approximate SBP  Reduction (Range)
Weight reduction to get BMI 18.5-25 Kg/m2 2-10 mm Hg/10 Kg
DASH eating (Most powerful modifier) (Fruits/vegetables/low saturated fat) 8-14 mmHg
Dietary Sodium reduction (<2 gm Na =< 6 gm NaCl) 2-8 mmHg
Aerobic physical activity (e.g 30 min walking most days of the week) Although I personally believe walking is not the best form of exercise as it consumes joints of the lower limb - bicycling is better as the weight is not burdening these joints as is swimming. 4-9 mmHg
Limit alcohol consumption to 2 drinks/day (30 ml alcohol = 24 oz beer =10 oz wine = 3 oz whiskey) or half that amount for women and smaller persons 2-4 mmHg
   
   
 

 

 

 

 

 

Compelling indications IN JNC 7 - 2003:

  1. Same as above but for
  2. Stroke prevention, Diuretic and ACE inhibitors.
  3. IHD BB or Long acting CCBs and Aldosterone antagonists.

More to follow.