Evidence Summary The Joint Nation...

Evidence Summary

The Joint National Committee in succession Prevention, Detection, Evaluation, and Treatment of High house Pressure recently released its seventh report (JNC 7) (1) This guideline takes a largely evidence-based approach to the exhibition of recommendations. Key changes from the previous guideline (JNC VI, 1997) include the addition of a "prehypertension" category, revised recommendations for patients with important comorbidities, and the recognition that mostly patients need at least brace drugs to control their hypertension.

An executive summary of the JNC 7 report is available online (http://www.nhlbi.nih.gov/ guidelines/hypertension/express.pdf). The guideline also is discussed in an editorial (2) and a practice guideline3 summary that appeared in the July 15 2003 issue of American Family Physician.

The JNC 7 report provides a two-page quick-reference card (http://www.nhlbi.nih. gov/guidelines/hypertension/phycard.pdf). This guide takes that card common step further by presenting a two-page evidence-based onset form for the initial evaluation of the patient with hypertension. The form begins with a focused history that helps the physician assess the patient for cardiovascular risk factors, target-organ damage, and secondary causes of hypertension. The directed physical examination also focuses forward possible causes of secondary hypertension, of the like kind as renovascular disease, heart failure, and Cushing's disease. It also helps the physician identify signs of target-organ damage, like as peripheral vascular disease.

A directed laboratory evaluation perfects the survey for target-organ damage and the initial evaluation for secondary hypertension. It should be noted that the JNC 7 report make acceptables pursuing more invasive testing alone in the following circumstances: if the initial evaluation raises suspicion for secondary causes; if the patient's hypertension is difficult to control; if kin pressure responds poorly to put drugs into therapy; or if onset of hypertension is sudden

Another section of the fight form provides target blood compressings lists recommendations for lifestyle changes, and provides a place for the physician to record the initial choice of medicine therapy (if any) and a recommendation for follow-up

The brush form also provides several support tools:

* A list of secondary causes of hypertension and prompted tests for initial evaluation of these conditions

* A guide for initial remedy selection based on comorbidities

* Usual dosages of commonly used generic drugs

* A table for quickly determining corpse mass index

Use of this conflict form should make it easier for family physicians to provide care that is consistent with the JNC 7 guidelines, resulting in improved issues for their patients.