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(Hypertension. 2003;42:1206.)
© 2003 American Heart Association, Inc.

JNC 7: Complete Report

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Aram V. Chobanian; George L. Bakris; Henry R. Black; William C. Cushman; Lee A. Green; Joseph L. Izzo, Jr; Daniel W. Jones; Barry J. Materson; Suzanne Oparil; Jackson T. Wright, Jr; Edward J. Roccella; the National High Blood Pressure Education Program Coordinating Committee

From Boston University School of Medicine (A.V.C.), Boston, Mass; Rush University Medical Center (G.L.B., H.R.B.), Chicago, Ill; Veterans Affairs Medical Center (W.C.C.), Memphis, Tenn; University of Michigan (L.A.G.), Ann Arbor, Mich; State University of New York at Buffalo School of Medicine (J.L.I. Jr.), Buffalo, NY; University of Mississippi Medical Center (D.W.J.), Jackson, Miss; University of Miami (B.J.M.), Miami, Fla; University of Alabama at Birmingham (S.O.), Birmingham, Ala; Case Western Reserve University (J.T.W. Jr.), Cleveland, Ohio; National Heart, Lung, and Blood Institute (E.J.R.), Bethesda, Md.

Correspondence to Edward J. Roccella, PhD, Coordinator, National High Blood Pressure Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 31, Room 4A10, 31 Center Drive MSC 2480, Bethesda, MD 20892. E-mail roccelle{at}nhlbi.nih.gov

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician’s judgment remains paramount.

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				Y. Yan, K. E. North, C. M. Ballantyne, F. L. Brancati, L. E. Chambless, N. Franceschini, G. Heiss, A. Kottgen, J. S. Pankow, E. Selvin, et al. Transcription Factor 7-Like 2 (TCF7L2) Polymorphism and Context-Specific Risk of Type 2 Diabetes in African American and Caucasian Adults: The Atherosclerosis Risk in Communities Study Diabetes, January 1, 2009; 58(1): 285 - 289. [Abstract] [Full Text] [PDF]

				A. L.B. Gunther, A. D. Liese, R. A. Bell, D. Dabelea, J. M. Lawrence, B. L. Rodriguez, D. A. Standiford, and E. J. Mayer-Davis Association Between the Dietary Approaches to Hypertension Diet and Hypertension in Youth With Diabetes Mellitus Hypertension, January 1, 2009; 53(1): 6 - 12. [Abstract] [Full Text] [PDF]

				L. F. Drager, L. A. Bortolotto, E. M. Krieger, and G. Lorenzi-Filho Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis Hypertension, January 1, 2009; 53(1): 64 - 69. [Abstract] [Full Text] [PDF]

				T. Ninomiya, Y. Kiyohara, Y. Tokuda, Y. Doi, H. Arima, A. Harada, Y. Ohashi, H. Ueshima, and for the Japan Arteriosclerosis Longitudinal Study Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease: An Overview From the Japan Arteriosclerosis Longitudinal Study Circulation, December 16, 2008; 118(25): 2694 - 2701. [Abstract] [Full Text] [PDF]

				R. Bakker, S. L. Rifas-Shiman, K. P. Kleinman, S. E. Lipshultz, and M. W. Gillman Maternal Calcium Intake During Pregnancy and Blood Pressure in the Offspring at Age 3 Years: A Follow-up Analysis of the Project Viva Cohort Am. J. Epidemiol., December 15, 2008; 168(12): 1374 - 1380. [Abstract] [Full Text] [PDF]

				W. B. Kannel and P. A. Wolf Framingham Study Insights on the Hazards of Elevated Blood Pressure JAMA, December 3, 2008; 300(21): 2545 - 2547. [Full Text] [PDF]

				R. C. Sherrick Will Running the Numbers First Violate the Principles of Patient-Centered Care? Ann Intern Med, December 2, 2008; 149(11): 839 - 840. [Full Text] [PDF]

				M.-A. Cornier, D. Dabelea, T. L. Hernandez, R. C. Lindstrom, A. J. Steig, N. R. Stob, R. E. Van Pelt, H. Wang, and R. H. Eckel The Metabolic Syndrome Endocr. Rev., December 1, 2008; 29(7): 777 - 822. [Abstract] [Full Text] [PDF]

				B. Radbill, B. Murphy, and D. LeRoith Rationale and Strategies for Early Detection and Management of Diabetic Kidney Disease Mayo Clin. Proc., December 1, 2008; 83(12): 1373 - 1381. [Abstract] [Full Text] [PDF]

				K. M Reinhart, C. I Coleman, C. Teevan, P. Vachhani, and C M. White Effects of Garlic on Blood Pressure in Patients With and Without Systolic Hypertension: A Meta-Analysis Ann. Pharmacother., December 1, 2008; 42(12): 1766 - 1771. [Abstract] [Full Text] [PDF]

				T. Tada, J. Nawata, H. Wang, N. Onoue, D. Zhulanqiqige, K. Ito, K. Sugimura, Y. Fukumoto, and H. Shimokawa Enhanced pulsatile pressure accelerates vascular smooth muscle migration: implications for atherogenesis of hypertension Cardiovasc Res, December 1, 2008; 80(3): 346 - 353. [Abstract] [Full Text] [PDF]

				J. W. Eriksson, P.-A. Jansson, B. Carlberg, A. Hagg, L. Kurland, M. K. Svensson, H. Ahlstrom, C. Strom, L. Lonn, K. Ojbrandt, et al. Hydrochlorothiazide, but not Candesartan, Aggravates Insulin Resistance and Causes Visceral and Hepatic Fat Accumulation: The Mechanisms for the Diabetes Preventing Effect of Candesartan (MEDICA) Study Hypertension, December 1, 2008; 52(6): 1030 - 1037. [Abstract] [Full Text] [PDF]