management of hypertension according to jnc 7 l.
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Management of Hypertension according to JNC 7. BY SANDAR KYI, MD. Introduction.

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Presentation Transcript
  • Hypertension is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge.
  • In the US: Forty-three million people are estimated to have hypertension
  • Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population
  • Generally, the higher the blood pressure, the greater the risk. Untreated hypertension affects all organ systems and can shorten one's life expectancy by 10 to 20 years.
  • The question is, what are the barriers to the management of hypertension according to JNC 7?.
  • It is a hypothesis that barriers to the effective management of patient with uncontrolled hypertension include
  • patient management time constraints,
  • physician practice patterns,
  • drug adverse effects, and
  • patient specific factors such as lack of adherence to therapy, limited access to care, financial barriers related to the cost of medications & lack of knowledge about the seriousness of uncontrolled hypertension.
  • Random chart reviews of 200 patients out of 500 charts those are following in FCC of RCRMC for hypertension from 2000-2006.
  • Sex – F:M 157:43
  • Race – Hispanic : Non-Hispanic

115 : 85

Smoker : Non Smoker - 58:142

  • Inclusion Criteria : pt with pre-hypertension, HTN stage 1,stage 2 according to JNC 7.
  • All charts were reviewed following factors:

- Demographic factor: age, sex, culture background, first language

-co-morbidity: hypercholesterolemia, IHD, diabetes

  • outcome of BP treatment:
  • acute coronary event (CP,angina, MI,CHF, bypass surgery)
  • stroke (TIA, CVA both ischemic and hemorrhagic)
  • BP whether reached goal BP or not
jnc vii report recommendations
JNC VII report recommendations
  • Initial therapy based on the JNC VII report recommendations is as follows:
  • Prehypertension (systolic 120-139, diastolic 80-89): No antihypertensive drug is indicated. (f/up BP measure within 1 yr).
  • Stage 1 hypertension (systolic 140-159, diastolic 90-99): Thiazide-type diuretics are recommended for most. ACE inhibitor, angiotensin II receptor blocker (ARB), beta-blocker, calcium channel blocker, or combination may be considered.
  • Stage 2 hypertension (systolic more than 160, diastolic more than 100): Two-drug combination (usually thiazide-type diuretic and ACE inhibitor or ARB or beta-blocker or calcium channel blocker) is recommended for most.
  • For the compelling indications, other antihypertensive drugs (eg, diuretics, ACE inhibitor, ARB, beta-blocker, calcium channel blocker) may be considered as needed.
numbers of patients with co morbidity
Numbers of patients with co-morbidity
  • In pts who reached goal BP - 18 (25%)
  • In pts who were non-compliant – 34 (52%)
  • In pts who didn’t take med: due to SE – 10 (32%)
  • In pts whose Dr not following JNC 7- 15 (47%)
  • Thus, according to this study, patient non-compliant had been identified as one of the main reasons that BP therapy fails.
  • Drug adverse effects have also been identified as a factor related to physician prescribing pattern of hypertensive medications.
  • Other findings seem to suggest that physicians are familiar with the JNC 7 guidelines for treating HTN but do not implement this knowledge into their everyday practice.
  • BP is one of the contributing factor to get complication but other co-morbidities (high cholesterol, DM ) can also contribute to complications.
  • This study clearly demonstrates that positive association between uncontrolled HTN & complication (such as cardiovascular disease , CVA,).
  • The finding of this study provide useful information for designing effective physician interventions for the management of patients with uncontrolled HTN.
limitations of research study
Limitations of Research Study
  • Small sample sizes with 6yrs duration.
  • Didn’t review patient cultural background, educational status, BMI, smoking history details, control of diabetic, & control of hypercholesterolemia.
  • Also not mentioned Duration of Physician time spent with pt. Usage of language interpreter if pt doesn’t speak English as first language.
  • Further extensive study to include following factors:
  • patient cultural background, educational status, BMI, smoking history details, control of diabetic & control of hypercholesterolemia.
  • Duration of Physician time spent with pt. Usage of language interpreter if pt doesn’t speak English as first language.
  • Barriers to Blood Pressure ControlG. Divakara Murthy Archives of Internal Medicine
  • E-medicine HTNSat Sharma, MD, FRCPC, FACP, FCCP, DABSM, Program Director, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Manitoba; Site Director of Respiratory Medicine, St Boniface General Hospital
  • The National High Blood Pressure Education Program