Tightening the Belt on Hypertension

Abstract & Commentary

Source: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). US Department of Health and Human Services. NIH Publication No. 03-5233. May 2003.

Hypertension is a major risk factor for both ischemic and hemorrhagic stroke. This and other risk factors for atherosclerosis are not merely issues for middle and late age. These are processes that begin early in life and cause cumulative damage to small and large arteries supplying the brain and within the brain. The recently released JNC 7 report is, therefore, of great importance to neurologists interested in stroke prevention.

The JNC report identifies "pre-hypertension" for individuals with blood pressures > 120 systolic or 80 diastolic (see Table). Although not recommended for antihypertensive medications, these BP goals mandate lifestyle modifications for a huge number of Americans previously not thought to be at increased risk. Lifestyle modifications include weight reduction, diet modification (low salt, low fat), aerobic exercise, and moderation of alcohol consumption. For those with Stage 1 or 2 hypertension, single-drug regimens may be insufficient, and there should be a low threshold for dual therapy (such as with an ACE inhibitor and a diuretic). Patient blood pressures should be aggressively checked at office visits, by outpatient BP monitors and by patient self checks.

Table

Blood pressure category 

Systolic  Diastolic
Normal   < 120 < 80

Prehypertension 

120-139  80-89
Hypertension, Stage 1   140-159 90-99

Hypertension, Stage 2  

> 160 > 100

Commentary

Untreated hypertension is an epidemic in this country. These new JNC guidelines further magnify this problem. It is incumbent upon neurologists and all health care professionals to educate our patients and encourage crucial lifestyle and pharmacologic interventions. — Alan Z. Segal

Dr. Segal is Assistant Professor, Department of Neurology, Weill-Cornell Medical College, Attending Neurologist, New York Presbyterian Hospital.