JNC 6 Vs 7

A Comparison of the Recommendations for Prevention, Detection, and Management of Hypertension made by the Sixth and Seventh Reports
of the Joint National Committee (JNC-6 vs. JNC-7) by Patrick O'Donnell
JNC-6
Classification: Category Optimal:** Normal: High-normal: HTN Stage 1 HTN Stage 2 HTN Stage 3 SBP <120 <130 130-139 140-159 160-179 180 DBP <80 <85 85-89 90-99 100-109 110
JNC-7
Classification: Category Normal: Prehypertension: HTN Stage 1 HTN Stage 2 SBP <120 120-139 140-159 160 DBP <80 80-89 90-99 100
Interpretation
The risk of CVD beginning with a BP of 115/75 doubles with each increase of 20/10 incrementally. The term Prehypertension was added this year to reflect an increased propensity to developing hypertension requiring physician intervention in the form of lifestyle modifications. Obesity and Physical Inactivity are entirely new risk factors in the JNC 7. These were included to stress the importance of lifestyle discussions with patients. Age was further specified between a man and woman. Microalbuminuria was added because it is a tangible reflection of nephropathy. After reviewing numerous RCCTs (Randomized Controlled Clinical Trials), instead of simply offering a broad class of medications as first line therapy, the JNC-7 stated to specifically use Thiazide-type diuretics for most patients as initial therapy. Again, based on various RCCTs, the JNC-7 greatly expanded its list of compelling indications for the use of specific drug therapies.
Major CVD Risk factors: Smoking FamHx: <65, <55 Dyslipidemia CVA or TIA Diabetes Mellitus Nephropathy Age >60 years Periph Arterial Dz Sex ( & post Retinopathy menopausal ) First line therapy for uncomplicated HTN: Oral antihypertensive drug: diuretic or beta blocker not otherwise specified. Compelling indications: DM1 with proteinuria ACE Heart Failure ACE, diuretic Isolated Sys HTN Diuretics, CCB MI BB, ACE (in Sys dysfxn)
Major CVD Risk Factors: Hypertension Physical Inactivity Obesity BMI >30 Microalbuminuria Dyslipidemia Age (>65, >55) Diabetes Mellitus FamHx: <65, <55 Cigarette Smoking First line therapy for uncomplicated HTN: Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB. Compelling indications: DM THIAZ, BB, ACE, ARB, CCB Heart Failure THIAZ, BB, ACE, ARB, ALDO ANT High CVD risk THIAZ, BB, ACE, CCB Post MI BB, ACE, ALDO ANT Chronic Kidney Dz ACE, ARB Recurrent Strokes THIAZ, ACE Target BP: Most patients Diabetes or Chronic Kidney Disease <140/90 <130/80
Target BP: Most patients Diabetes Mellitus Chronic Proteinuria Kidney <1g/24h Disease: Proteinuria >1g/24h
<140/90 <130/85 <130/85 <125/75
The target blood pressure was updated to include two groups instead of 4: a goal of <140/90 was settled for most patients, and <130/80 for patients with DM or CRI.
When to use 2 agents: Not at goal blood pressure after optimizing dosage.
When to use 2 agents: Not at goal blood pressure after optimizing dosage; or When patient develops Stage 2 HTN (SBP160 or DBP 100): usually HCTZ + [ACE or ARB or BB or CCB]
Interestingly, the JNC-7 became more aggressive with the use of dual therapy, recommending the use of two agents for any patient with Stage 2 HTN.
Transitioning from the guidelines set forth by the JNC-6 to those outlined in the JNC-7 eased the plight of the physician responsible for managing Hypertension. The JNC-7 put forth greater emphasis on lifestyle changes in the aggressive management of early signs of HTN as evidenced by categorizing Prehypertension. The JNC-7 also took advantage of recent RCCTs to offer physicians tangible recommendations for first line therapy, compelling indications, target BP as outlined above.
A Comparison of the Recommendations for Prevention, Detection, and Management of Hypertension made by the Sixth and Seventh Reports of the Joint National Committee (JNC-6 vs. JNC-7) by Patrick O'Donnell
References: -Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Committee (1997). The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 6). Archives of Internal Medicine, 157: 24132446. -Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 035233. Bethesda, MD: U.S. Department of Health and Human Services.
Transitioning from the guidelines set forth by the JNC-6 to those outlined in the JNC-7 eased the plight of the physician responsible for managing Hypertension. The JNC-7 put forth greater emphasis on lifestyle changes in the aggressive management of early signs of HTN as evidenced by categorizing Prehypertension. The JNC-7 also took advantage of recent RCCTs to offer physicians tangible recommendations for first line therapy, compelling indications, target BP as outlined above.

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JNC 6 Vs 7

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A Comparison of the Recommendations for Prevention, Detection, and Management of Hypertension made by the Sixth and Seventh Reports

of the Joint National Committee (JNC-6 vs. JNC-7) by Patrick O'Donnell

<140/90 <130/85 <130/85 <125/75

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