Jnc 9 Guidelines For Hypertension Pdf Download 2021

Meta-analyses of observational studies have shown that elevated blood pressure (BP) and hypertension are associated with an increased risk of cardiovascular disease (CVD), end-stage renal disease, subclinical atherosclerosis, and all-cause mortality. A person's risk of hypertension is influenced by various genetic and environmental factors, such as being overweight or obese; diet; alcohol intake; and fitness level. The American College of Cardiology (ACC) and American Heart Association (AHA) recently updated their guideline on the prevention, detection, evaluation, and treatment of high BP in adults. The ACC/AHA recommendations were based on a systematic review that addressed the following questions:

Estimates of the prevalence of hypertension are greatly influenced by the choice of cutoffs used to categorize elevated BP and hypertension, the methods used to establish the diagnosis, and the population studied. The prevalence of hypertension among U.S. adults is substantially higher when the definitions in this guideline are used vs. the definitions in the Seventh Report of the Joint National Committee, but nonpharmacologic therapy would be recommended for most patients with newly diagnosed hypertension based on the current guideline.

Jnc 9 Guidelines For Hypertension Pdf Download

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To prevent and treat hypertension, BP should first be categorized as normal (less than 120 mm Hg systolic and less than 80 mm Hg diastolic), elevated (120 to 129 mm Hg systolic and less than 80 mm Hg diastolic), stage 1 hypertension (130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic), or stage 2 hypertension (at least 140 mm Hg systolic or at least 90 mm Hg diastolic). Patients whose systolic and diastolic BPs are in different categories should be assigned to the higher category (i.e., a patient with a BP of 128/82 mm Hg should be diagnosed with stage 1 hypertension).

Although BP measurement in the office setting is relatively easy, errors are common and can result in a misleading estimation of a patient's true BP. Accurate measurement and recording are essential to categorize BP, ascertain BP-related CVD risk, and guide management of hypertension. Most systematic errors in BP measurement can be avoided by having the patient sit quietly for five minutes before a reading is taken, supporting the limb used to measure BP, ensuring the BP cuff is at heart level, using the correct cuff size, and deflating the cuff slowly. Because individual BP measurements tend to vary, a single reading is inadequate for clinical decision making. Using the average of two or three measurements taken on two or more separate occasions will minimize random error and provide a more accurate basis for estimation of BP. Out-of-office BP measurement in conjunction with telehealth counseling or clinical interventions is recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. ABPM is generally accepted as the best out-of-office method, but HBPM is often a more practical approach.

White coat hypertension is characterized by elevated BP measurements in the office setting but normal readings on ABPM or HBPM. In contrast, masked hypertension is characterized by normal office readings but ABPM/HBPM readings that are consistently above normal. The risk of CVD and all-cause mortality in persons with masked hypertension is similar to that in those with sustained hypertension, and about twice as high as in persons with normal BP. Some studies have identified a small increase in the risk of CVD complications and all-cause mortality in patients with white coat hypertension.

The prevalence of white coat hypertension ranges from 13% to as high as 35% in some populations. In adults with untreated systolic BP greater than 130 mm Hg but less than 160 mm Hg, or diastolic BP greater than 80 mm Hg but less than 100 mm Hg, it is reasonable to screen for white coat hypertension using daytime ABPM or HBPM before the diagnosis of hypertension is made. Screening for masked hypertension with ABPM or HBPM is reasonable in adults whose untreated office BP is consistently 120 to 129 mm Hg systolic or 75 to 79 mm Hg diastolic.

First-line agents include thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Initiation of BP-lowering therapy with two first-line agents of different classes (as separate agents or in a fixed-dose combination) is recommended for adults with stage 2 hypertension and an average BP more than 20/10 mm Hg above their target. Therapy with a single agent is reasonable in adults with stage 1 hypertension and target BP less than 130/80 mm Hg. The dosage should be titrated and additional agents added sequentially to achieve the BP target. Simultaneous use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and/or renin inhibitor is not recommended.

A target BP of less than 130/80 mm Hg is recommended for adults with confirmed hypertension and CVD or a 10-year atherosclerotic CVD risk of 10% or more. A target of less than 130/80 mm Hg may be reasonable for adults with confirmed hypertension but no additional markers of increased CVD risk. Target BPs for adults with hypertension and comorbid conditions are shown in Table 1.

Adults with elevated BP or stage 1 hypertension whose estimated 10-year risk of atherosclerotic CVD is less than 10% should be treated with nonpharmacologic interventions and reevaluated in three to six months. Those with stage 1 hypertension whose estimated risk is 10% or more should receive BP-lowering therapy in conjunction with nonpharmacologic interventions, then undergo repeat evaluation in one month. Adults with stage 2 hypertension should be evaluated by or referred to a primary care physician within one month, receive a combination of nonpharmacologic interventions and BP-lowering medications (with two agents from different classes), and undergo repeat evaluation in one month. Adults with very high BPs (systolic BP of 180 mm Hg or higher, or diastolic BP of 110 mm Hg or higher) should be evaluated quickly and provided drug therapy.

Editor's Note: The American Academy of Family Physicians (AAFP) does not endorse the 2017 ACC/AHA guideline on hypertension and continues to endorse the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. The AAFP also supports its 2017 guideline, which was codeveloped with the American College of Physicians: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets ( -care/clinical-recommendations/all/hypertension-over-60.html). For more details, see the accompanying editorial by Dr. LeFevre and AAFP News article ( -of-the-public/20171212notendorseaha-accgdlne.html).

What do your blood pressure numbers mean?The only way to know if you have high blood pressure, also known as hypertension, is to have your blood pressure tested. Understanding your results is key to controlling high blood pressure.

*All health/medical information on this website has been reviewed and approved by the American Heart Association, based on scientific research and American Heart Association guidelines. Find more information on our content editorial process.

High blood pressure, also called hypertension, is blood pressure that is higher than normal. Your blood pressure changes throughout the day based on your activities. Having blood pressure measures consistently above normal may result in a diagnosis of high blood pressure (or hypertension).

Your health care team can diagnose high blood pressure and make treatment decisions by reviewing your systolic and diastolic blood pressure levels and comparing them to levels found in certain guidelines.

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.

Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease.

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions.

Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can cause:

The prevalence of hypertension varies across regions and country income groups. The WHO African Region has the highest prevalence of hypertension (27%) while the WHO Region of the Americas has the lowest prevalence of hypertension (18%).

The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low- and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations.tag_hash_109

In 2021, WHO released a new guideline for on the pharmacological treatment of hypertension in adults. The publication provides evidence-based recommendations for the initiation of treatment of hypertension, and recommended intervals for follow-up. The document also includes target blood pressure to be achieved for control, and information on who, in the health-care system, can initiate treatment.

In September 2017, WHO began a partnership with Resolve to Save Lives, an initiative of Vital Strategies, to support national governments to implement the Global Hearts Initiative. Other partners contributing to the Global Hearts Initiative are the CDC Foundation, the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization (PAHO) and the U.S. CDC. Since implementation of the programme in 2017 in 31 countries low- and middle-income countries, 7.5 million people have been put on protocol-based hypertension treatment through person-centred models of care. These programmes demonstrate the feasibility and effectiveness of standardized hypertension control programmes. e24fc04721