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on December 1, 2003

Hypertension. 2003
Published online before print December 1, 2003, doi: 10.1161/01.HYP.0000107251.49515.c2
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Submitted on November 5, 2003
Revised on November 6, 2003

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*; and 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.

* To whom correspondence should be addressed. E-mail: roccelle{at}nhlbi.nih.gov.

Abstract--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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P. S Sever, A. H Gradman, and M. Azizi
Managing cardiovascular and renal risk: the potential of direct renin inhibition
Journal of Renin-Angiotensin-Aldosterone System, June 1, 2009; 10(2): 65 - 76.
[Abstract] [PDF]


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Am J Health Syst PharmHome page
S. S. Shord, L. R. Bressler, L. A. Tierney, S. Cuellar, and A. George
Understanding and managing the possible adverse effects associated with bevacizumab
Am. J. Health Syst. Pharm., June 1, 2009; 66(11): 999 - 1013.
[Abstract] [Full Text] [PDF]


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Ther Adv Cardiovasc DisHome page
F. Elijovich and C. Laffer
A role for single-pill triple therapy in hypertension
Therapeutic Advances in Cardiovascular Disease, June 1, 2009; 3(3): 231 - 240.
[Abstract] [PDF]


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J. Clin. Endocrinol. Metab.Home page
M. B. Lodish, N. Sinaii, N. Patronas, D. L. Batista, M. Keil, J. Samuel, J. Moran, S. Verma, J. Popovic, and C. A. Stratakis
Blood Pressure in Pediatric Patients with Cushing Syndrome
J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 2002 - 2008.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
C. A. Faria, R. S. Moraes, D. C. Sobral-Filho, A. G. Rego, M. F.P. Baracho, E. S.T. Egito, and J. Brandao-Neto
Autonomic modulation in patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome)
Europace, June 1, 2009; 11(6): 763 - 769.
[Abstract] [Full Text] [PDF]


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Exp PhysiolHome page
A. Ceroni, L. J. Chaar, R. L. Bombein, and L. C. Michelini
Chronic absence of baroreceptor inputs prevents training-induced cardiovascular adjustments in normotensive and spontaneously hypertensive rats
Exp Physiol, June 1, 2009; 94(6): 630 - 640.
[Abstract] [Full Text] [PDF]


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CirculationHome page
R. Mogelvang, P. Sogaard, S. A. Pedersen, N. T. Olsen, J. L. Marott, P. Schnohr, J. P. Goetze, and J. S. Jensen
Cardiac Dysfunction Assessed by Echocardiographic Tissue Doppler Imaging Is an Independent Predictor of Mortality in the General Population
Circulation, May 26, 2009; 119(20): 2679 - 2685.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. G. Allison
Improving Weight Loss in Cardiac Rehabilitation
Circulation, May 26, 2009; 119(20): 2650 - 2652.
[Full Text] [PDF]


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ANN INTERN MEDHome page
P. A. Sarafidis and G. L. Bakris
Does Evidence Support Renin-Angiotensin System Blockade for Slowing Nephropathy Progression in Elderly Persons?
Ann Intern Med, May 19, 2009; 150(10): 731 - 733.
[Full Text] [PDF]


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NeurologyHome page
L. B. Hoffman, J. Schmeidler, G. T. Lesser, M. S. Beeri, D. P. Purohit, H. T. Grossman, and V. Haroutunian
Less Alzheimer disease neuropathology in medicated hypertensive than nonhypertensive persons
Neurology, May 19, 2009; 72(20): 1720 - 1726.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
E. S. Muxfeldt, C. R. L. Cardoso, and G. F. Salles
Prognostic Value of Nocturnal Blood Pressure Reduction in Resistant Hypertension
Arch Intern Med, May 11, 2009; 169(9): 874 - 880.
[Abstract] [Full Text] [PDF]


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NEJMHome page
D. Terentes-Printzios, C. Vlachopoulos, C. Stefanadis, S. K. Dudeja, R. K. Dudeja, J. S. Williams, S. Brown, and P. R. Conlin
Blood-Pressure Measurement
N. Engl. J. Med., May 7, 2009; 360(19): 2034 - 2035.
[Full Text] [PDF]


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J Am Board Fam MedHome page
D. L. Howard, A. P. Carson, D. N. Holmes, and J. S. Kaufman
Consistency of Care and Blood Pressure Control among Elderly African Americans and Whites with Hypertension
J Am Board Fam Med, May 1, 2009; 22(3): 307 - 315.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc Qual OutcomesHome page
P. T. Einhorn
National Heart, Lung, and Blood Institute-Initiated Program "Interventions to Improve Hypertension Control Rates in African Americans": Background and Implementation
Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 236 - 240.
[Full Text] [PDF]


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Circ Cardiovasc Qual OutcomesHome page
G. Ogedegbe, J. N. Tobin, S. Fernandez, W. Gerin, M. Diaz-Gloster, A. Cassells, C. Khalida, T. Pickering, A. Schoenthaler, and J. Ravenell
Counseling African Americans to Control Hypertension (CAATCH) Trial: A Multi-Level Intervention to Improve Blood Pressure Control in Hypertensive Blacks
Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 249 - 256.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
S. W. Rhee, J. R. Stimers, W. Wang, and L. Pang
Vascular Smooth Muscle-Specific Knockdown of the Noncardiac Form of the L-Type Calcium Channel by MicroRNA-Based Short Hairpin RNA as a Potential Antihypertensive Therapy
J. Pharmacol. Exp. Ther., May 1, 2009; 329(2): 775 - 782.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
H. Izzedine, S. Ederhy, F. Goldwasser, J. C. Soria, G. Milano, A. Cohen, D. Khayat, and J. P. Spano
Management of hypertension in angiogenesis inhibitor-treated patients
Ann. Onc., May 1, 2009; 20(5): 807 - 815.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc Qual OutcomesHome page
S. J. Lewis, K. M. Fox, M. F. Bullano, S. Grandy, and for the SHIELD Study Group
Knowledge of Heart Disease Risk Among SHIELD Respondents With Dyslipidemia
Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 207 - 212.
[Abstract] [Full Text] [PDF]


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StrokeHome page
P. C. Lavallee, J. Labreuche, F. Gongora-Rivera, A. Jaramillo, D. Brenner, I. F Klein, P.-J. Touboul, E. Vicaut, P. Amarenco, and on behalf of the Lacunar-B.I.C.H.A.T. Investigator
Placebo-Controlled Trial of High-Dose Atorvastatin in Patients With Severe Cerebral Small Vessel Disease
Stroke, May 1, 2009; 40(5): 1721 - 1728.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
J. Am. Coll. Cardiol., April 14, 2009; 53(15): e1 - e90.
[Full Text] [PDF]


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CirculationHome page
2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
Circulation, April 14, 2009; 119(14): e391 - e479.
[Full Text] [PDF]


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NEJMHome page
A. V. Tess and G. W. Smetana
Medical Evaluation of Patients Undergoing Electroconvulsive Therapy
N. Engl. J. Med., April 2, 2009; 360(14): 1437 - 1444.
[Full Text] [PDF]


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Eur J EndocrinolHome page
M. Sereg, A. Szappanos, J. Toke, K. Karlinger, K. Feldman, E. Kaszper, I. Varga, E. Glaz, K. Racz, and M. Toth
Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study
Eur. J. Endocrinol., April 1, 2009; 160(4): 647 - 655.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
B. E. de Galan, V. Perkovic, T. Ninomiya, A. Pillai, A. Patel, A. Cass, B. Neal, N. Poulter, S. Harrap, C.-E. Mogensen, et al.
Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
J. Am. Soc. Nephrol., April 1, 2009; 20(4): 883 - 892.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
P. Muntner, M. Krousel-Wood, A. D. Hyre, E. Stanley, W. C. Cushman, J. A. Cutler, L. B. Piller, G. A. Goforth, and P. K. Whelton
Antihypertensive Prescriptions for Newly Treated Patients Before and After the Main Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Results and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines
Hypertension, April 1, 2009; 53(4): 617 - 623.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
R. D. Feldman and F. A. McAlister
Postgame Wrap of the Ultimate Blood Pressure Megatrial: Did It Score an ALLHAT Trick or Was It "Three Strikes and You're Out?"
Hypertension, April 1, 2009; 53(4): 595 - 597.
[Full Text] [PDF]


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HypertensionHome page
P. C. Schulze
Beneficial Effects of Moderate Exercise in Arterial Hypertension
Hypertension, April 1, 2009; 53(4): 600 - 601.
[Full Text] [PDF]


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J Am Coll CardiolHome page
J. M. Tobis and A. Perlowski
Atheroma volume by intravascular ultrasound as a surrogate for clinical end points.
J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1116 - 1118.
[Full Text] [PDF]


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CirculationHome page
CORONARY REVASCULARIZATION WRITING GROUP, M. R. Patel, G. J. Dehmer, J. W. Hirshfeld, P. K. Smith, and J. A. Spertus
ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology: Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography
Circulation, March 10, 2009; 119(9): 1330 - 1352.
[Full Text] [PDF]