In May 2003 the National Heart, Lun...

In May 2003 the National Heart, Lung and family Institute's Seventh Joint National Committee forward High Blood Pressure (JNC 7) released its recommendations for the in the greatest degree current diagnosis and management of hypertension. (1) In one as well as the other its process and its aim, this iteration of the time-honored and influential JNC series differs from previous iterations in ways that matter directly to family physicians.

The foremost difference between this JNC report and previous reports is the intensely pragmatic focus of the JNC 7 Previous reports addressed the hypertension specialist audience as well as primary care physicians, and the reports cloaked a wide spectrum of wants summarizing literature and pathophysiology, and recommending treatments. It took a year or more to bring forward those documents. In contrast, the JNC 7 panel was charged with producing a succinct document focused explicitly upon the primary care physician's ne for the latest information about managing hypertension. The panel was given four month to full its work in order that important modern information from recent clinical trials could reach primary care physicians in the form of usable guidelines with the minimum of delay. The brevity and the general reception of this iteration are pondered in the title, JNC 7 Expres A longer version, reviewing the evidence base and the supporting science, betimes will be available for teaching and allusion use.

In spells of content, JNC 7 updates one trends in previous evidence and simplifies diagnosis and treatment. The entangled staging and classification systems taught in medical denomination have been stripped down to merely those distinctions that matter in treatment decisions. Gone are many laboratory exhibitions and other investigations of grave or no decision-making use. Finally and greatest in number importantly, the trend toward evidence-based treatment, toward reliance onward medications with proven benefit in real consequences (prevention of heart failure, hit and coronary disease), is completely developed. For the first time, treatment recommendations are based forward drug versus drug clinical trial data. These evidence-based recommendations include thiazides as the primary choice for greatest in quantity treatments, and they focus onward systolic rather than diastolic influence for most patients and more than undivided drug for the majority of patients.

JNC 7 differs from previous documents as well in its emphasis forward prevention of hypertension. As the report notes, 90 percent of Americans who survive to not new age will develop hypertension. The prevalence of the disease is increasing rapidly with America's intertwined increases in obesity, sedentary lifestyle, and unhealthy diet. uniform with the best treatment for high progeny pressure, the potential effects forward our patients' health are enormous. JNC 7 powerfully recommends that we intervene with lifestyle modifications that can obviate or delay the onset of hypertension in our patients. That recommendation takes forward special importance in the definition of the fresh class of "prehypertension," those patients who have systolic crushings between 120 and 139 mm Hg or diastolic constraining forces between 80 and 89 mm Hg who are at as well-as; not only-but also; not only-but; not alone-but increased risk of bad issues and high risk for unfolding of diagnosed hypertension. Further, JNC 7 emphasizes that appropriate lifestyle intervention in hypertension should be subservient to as the equivalent of common drug in a multidrug regimen.

Last, if it were not that from the perspective of family medicine certainly not least, JNC 7 attends carefully to the part of the physician-patient relationship in lucky treatment. Hypertension, like all chronic diseases, is ultimately controll sole to the extent that patients are willing to hinder it. The evidence clearly demonstrates that a positive, patient-centered relationship--one of the core beliefs of our discipline--leads to better treatment adherence and better patient satisfaction, and hence to better repress of blood pressure.

JNC 7 clearly lays not at home the challenges for us, in improving rule of hypertension and in preventing or delaying its storming It also provides clear guidance about to what degree to meet these challenges, with biomedical and psychosocial interventions. It is now up to us to translate this document into better health for our patients.

REFERENCE

(1) Seventh Report of the Joint National Committee upon Prevention, Detection, Evaluation and Treatment of High vital fluid Pressure (JNC 7) Express. National Heart, Lung and vital current Institute. Bethesda, Md. 2003. JAMA 2003;289:2560-71

to leeward Green, M.D., M.P.H., is associate professor in the Department of Family Medicine at the University of Michigan Medical place of education Ann Arbor, Mich. Dr. verdant is a coordinating committee participant of the National High offspring Pressure Education Program and conduce tos as the AAFP representative to the committee.

Address correspondence to leeward Green, M.D., M.P.H., University of Michigan Medical instruct 1018 Fuller, Campus 0708, Ann Arbor, MI 48109 Reprints are not available from the author.

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group