JNC 7 ESH/ESC (Guidelines)
Guidelines 2003. 5 JNC 7 Guidelines ; The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JAMA. 2003;289:2560-2572. 2003. 6 ESH/ESC Guidelines ; 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension* Guidelines Committee** Journal of Hypertension 2003;21:1011-1053. 2003. 11 WHO/ISH Guidelines ; 2003 World Health organization (WHO)/ International Society of Hypertension (ISH) statement on management of hypertension World Health Organization, International Society of Hypertension Writing Group Journal of Hypertension 2003;21:1983-1992.
(Guideline) Dynasty C.C.
JNC 7 Express Succinct evidencebased recommendations. Published in JAMA May 21, 2003, and as a Government Printing Office publication. Full Report comprehensive justification and rationale.
Why JNC 7? : Purpose
: JNC 6-7 Categorization of hypertension by severity Categroy Systolic Diastolic(mmHg) Optimal < 120 < 80 Normal < 130 <120 and < 85 < 80 High-normal 130-139 or 85-89 Prehypertension 120-139 80-89 Hypertension Stage 1 140-159 or 90-99 Stage 2 160-179 or 100-109 Stage 2 160 or 100 Stage 3 180 or 110 JNC VI JNC VII
: JNC 7 BP Classification Systolic (mmhg) Diastolic (mmhg) Normal < 120 < 80 Prehypertension 120-139 80-89 Stage 1 Hypertension 140-159 90-99 Stage 2 Hypertension 160 100
: ESH/ESC Definitions and classification of blood pressure levels (mmhg)
: WHO/ISH Definitions and classification of blood pressure levels (mmhg) Category Systolic Diastolic Optimal < 120 < 80 Normal 120-129 80-84 High normal 130-139 85-89 Grade 1 hypertension (mild) 140-159 90-99 Subgroup : Borderline 140-149 90-94 Grade 2 hypertension (moderate) 160-179 100-109 Grade 3 hypertension (severe) 180 110 Isolated systolic hypertension 140 > 90 Subgroup : Borderline 140-149
JNC 7 : Key Messages(1) 50 SBP DBP CVD CVD risk 115/75 mmhg 20/10mmHg 2 90% 55 (prehypertension) : 120-139/80-89 mmhg
JNC 7 : Key Messages(2) Thiazide ( ) (compelling indications) : 2 20/10 mmhg 2 : thiazide
JNC 7 : Key Messages(3) = + = + (empathy):
JNC-7 : < 120/80 mmhg 130-139/85-89 mmhg (Prehypertension) : (LSM) 120-139/80-89 mmhg : 2 (stage III II )
JNC-7 (Lifestyle Modification) (DASH diet) 1 6gm (Na 2.4gm, 100mmol) ( 18.5-24.9 kg/m 2 ), ( 30 ) 2 (100% ethanol 30ml ; 720ml, 300ml, 80 90ml ) ( ) 5-20 mmhg/10 kg 8-14 mmhg 2-8 mmhg 4-9 mmhg 2-4 mmhg
JNC-7
JNC-7 Thiazide - ALLHAT - -
JNC-7 20/10 mmhg
JNC-7 : Compelling Indications ACE
JNC-7 3 (Stage 3) -2 160 mmhg 100 mmhg (3 : 180 mmhg 110mmHg) -
JNC-7 (Risk Stratification) - - 120/80 mmhg - : (NIDDM) - +
ESH/ESC Stratification of risk to quantify prognosis
Ten-year risk of fatal cardiovascular disease in populations at low cardiovascular disease risk. Chart based on total cholesterol.
WHO/ISH Stratification of risk to quantify prognosis
JNC-7 /ESH-ESC Cardiovascular Risk Factors and Target Organ Damage(JNC 7) MAJOR RISK FACTORS Hypertension * Cigarette smoking Obesity* (body mass index 30 kg/m 2 ) Physical inactivity Dyslipidemia * Diabetes mellitus * Microalbuminuria or estimated GFR <60 ml/min Age(older than 55 for men, 65 for women) Familly history of premature cardiovascular disease (men under age 55 or women under age 65) TARGET ORGAN DAMAGE Heart Left ventricular hypertrophy Angina or prior myocardial infarction Prior coronary revascularization Heart failure Brain Storke or transient ischemic attack Chronic Kidney disease Peripheral arterial disease Retinopahty GRF, glomerular filtration ratel. * Components of the metabolic syndrome.
Factors Influencing Prognosis(ESH-ESC) Risk factors for cardiovascular disease used for stratificaton Levels of systolic and diastolic BP Men > 55 years Women > 65 years Smoking Dyslipidaemia (total cholesterol > 250mg/dl * ) or LDL-cholesterol > 155mg/dl * or HDL-cholesterol M < 40, W < 48 mg/dl) Family history or premature cardiovascular disease (at age < 55 years M, < 65 years W) Abdominal obesity (abdominal circumference M 102cm, W 88cm) C-reactive protein 1 mg/dl
Factors influencing prognosis(esh-esc) Target organ damage (TOD) Left ventricular hypertrophy (electrocardiogram: Sokolow-Lyons >38 mm; Cornell > 240 mm*ms; echocardiogram: LVMI M 125, W 110 g/m 2 ) Ultrasound evidence of arterial wall thickening (carotid IMT 0.9 mm) or atherosclerotic plaque Slight increase in serum creatinine ( M 13.-1.5, W 1.2-1.4 mg/dl) Microalbuminuria (30-300 mg/24 h; albumin-creatinine ratio M 22, W 31 mg/g;)
Factors Influencing Prognosis(ESH-ESC) Diabetes mellitus Fasting plasma glucose 126 mg/dl (7.0 mmol/l ) Prostprandial plasma glucose > 198 mg/dl (11.0 mmol/)
Factors Influencing Prognosis(ESH-ESC) Associaged clinical conditions (ACC) Cerebrovascular disease: ischaemic stroke; cerebral haemorrhage; transient ischaemic attack Heart disease: myocardial infarction; angina; coronary revascularization;congestive heart failure Renal disease: diabetic nephropathy; renal impaiment (serum creatinine M >1.5, W > 1.4 mg/dl) proteinuria (>300 mg/24 h) Peripheral vascular disease Advanced retinopathy; haemorrhages or exudates, papilloedema
JNC-7 : <140/90mmHg ( : <130/80mmHg) 1 Thiazide ACEI, ARB, BB, CCB 2 2 thiazide ACEI, ARB, BB, CCB :, ACEI, ARB, BB, CCB
Initiation of Antihypertensive Treatment: ESH-ESC
Choice Between Monotherapy and Combination Therapy ESH-ESC Guidelines
Possible Combinations of Different Classes of Antihypertensive Agents: ESH-ESC Guidelines
JNC 7/ESH-ESC
JNC-7 /ESH-ESC (mmhg) - Normal BP : < 120/80 Optimal BP : < 120/80 - Prehypertension : 120-139/80-89 Normal : 120-129/80-84 High normal : 130-139/85-89 - Stage II = Grade 2 + Grade 3 Hypertension
JNC-7 /ESH-ESC JNC 7 : ESH/ESC : Added risk
JNC-7 /ESH-ESC JNC 7 : Normal < 120/80 mmhg Prehypertension : Stage III Stage II ESH-ESC :,
Patients (%) with BP Controlled Worldwide JNC VI. Arch Intern Med 1997;157:2413 Joffres et al. Am J Hypertens 1997;10:1097 Colhourn et al. J Hypertens 1998;16:747
Patients (%) with BP Controlled Worldwide Chamontin et al. Am J Hypertens 1998;11(6 pt 1):1097 Marques-Vidal and Tuomilehto. J Hum Hypertens 1997;11:213
JNC-7 Message :
: JNC 7 Guidelines Thiazide
ESH-ESC Message :
JNC 7 ESH-ESC Dynasty C.C. Dynasty C.C 3.5Km Dynasty C.C. Dynasty C.C 16Km Dynasty C.C 34Km
FDR
Table I. FDR A Case of Untreated Hypertension YEAR BLOOD PRESSURE COMPLICATIONS TREATMENT (MM HG) 1935 136/78 age 53 1937 162/98 Phenobarbital 1937-1941 170-180/90-100 Low-salt and low-fat diet Massages Digitalis 1941 188/105 Cardiac enlargment Probable lacunar infarcts 1944 186/108 Congestive heart failure (CHF) 1944-1945 180-240/110-130 Renal failure April 12, 1945 cerebral hemorrhage death, age 63 : BP > 300/190 mmhg
1. JNC 7/ ESH-ESC - - 2. guidelines?. 3. guidelines? JNC 7 Guidelines? ESH/ESC Guidelines? WHO/ISH Guidelines?