Hypertension and JNC 7/8 Guidelines Flashcards

Hypertension and JNC Guidelines

• Systolic Blood Pressure: Identified as a more critical risk factor for cardiovascular disease (CVD) than diastolic pressure according to JNC 7.

• CVD Risk Increase: Starting at a blood pressure of 115/75 mmHg, the risk of CVD doubles with every increase of 20/10 mmHg.

• Lifetime HTN Risk: 90% of normotensive individuals at age 55 are likely to develop hypertension during their lifetime.

• Pre-hypertensive Range: Blood pressure readings of 120-139 systolic and 80-89 diastolic mmHg categorize individuals as pre-hypertensive.

• Initial Drug Therapy: Thiazide-type diuretics are recommended as the first-line treatment for most cases of hypertension.

• Medication Requirements: Most patients require two or three antihypertensive drugs to reach their target blood pressure.

Blood Pressure Classifications

• Normal BP: Defined as systolic < 120 mmHg and diastolic < 80 mmHg.

• Pre-hypertension: Defined as systolic between 120-139 mmHg or diastolic between 80-89 mmHg.

• Stage 1 Hypertension: Classified as systolic 140-159 mmHg or diastolic 90-99 mmHg.

• Stage 2 Hypertension: Classified as systolic ≥ 160 mmHg or diastolic ≥ 100 mmHg.

Differences in Guidelines

• Beta Blockers Exclusion: JNC 8 did not include beta blockers as a recommended initial drug treatment for hypertension.

Hypertension Types

• Isolated Systolic Hypertension: Characterized by systolic > 140 mmHg with diastolic ≤ 90 mmHg.

• Malignant Hypertension: Defined as systolic ≥ 200 mmHg and diastolic ≥ 140 mmHg, often with serious complications.

• Primary Hypertension: Refers to hypertension without an identifiable cause.

• Secondary Hypertension: Hypertension linked to identifiable causes such as renal, endocrine, neurological factors, or pregnancy.

Prevalence and Awareness

• HTN Prevalence: Approximately 67 million people in the United States are affected by hypertension.

• Untreated HTN: 53.5% of individuals with hypertension do not have their condition under control.

• Unawareness of HTN: About 38.4% of people with hypertension are unaware of their condition.

• Non-compliance: 15.8% of individuals diagnosed with hypertension are not taking any medications.

• Treatment with Medication: 44.8% of those who know they have hypertension are currently on medication.

Monitoring Blood Pressure

• Measurement Variability: The standard deviation for OTC automatic blood pressure measurement is ± 20 mmHg.

• White Coat Hypertension: Elevated blood pressure in a clinical setting, normal readings outside the office suggest a need for further evaluation.

• Ambulatory Measurement: Recommended for cases of "white coat" hypertension without target organ damage.

• Pressure Comparison: Ambulatory blood pressure is typically lower than clinic measurements.

• Nighttime BP Drop: Blood pressure usually drops by 10-20% during the night.

Benefits of Self-Measurement

• Self-Monitoring Insights: Provides valuable information on response to antihypertensive therapy, adherence to treatment, and assessment of white coat hypertension.

• Home Measurement Threshold: A reading of 135/85 mmHg is considered hypertensive when measured at home.

Risk Factors for Cardiovascular Disease

• CVD Risk Factors: Include hypertension, obesity, dyslipidemia, diabetes mellitus, and a family history of premature CVD (men under 55, women under 65).

• Sleep Apnea Association: Sleep apnea is a common identifiable cause of hypertension, present in about 50% of patients with heart disease.

Health Impacts of Hypertension

• Heart Damage: Conditions linked to hypertension include left ventricular hypertrophy, angina, prior myocardial infarction, coronary revascularization, and heart failure.

• Brain Damage: Hypertension is a risk factor for stroke and transient ischemic attacks (TIA).

Recommended Tests for Hypertension

• Indicated Diagnostic Tests: Include electrocardiograms, urinalysis, blood glucose, hematocrit, serum potassium, creatinine, calcium levels, and lipid profiles.