JNC 7 Hypertension Reference Card

JNC 7 Hypertension Reference Card

Question. Describe JNC VII criteria for hypertension. Write in brief investigations and outline treatment.

Answer. JNC VII criterias is the 7th report of the Joint National Committe on Prevention Detection, Evaluation and Treatment of High Blood Pressure.

Jnc vII criteria for Hypertension

Hypertension should be based on average of two or more readings taken at each of two or more visits after initial reading.

Investigations Criteria For Hypertension

1. Routine tests: criteria for hypertension

1. Urinalysis: Detection of proteinuria and microscopic hematuria may indicate some degree of renal arteriolar necrosis and nephrosclerosis, or underlying intrinsic renal disease such as polycystic kidneys, chronic pyelonephritis or glomerulonephritis.
2. Serum biochemistry: High sodium and low potassium may suggest primary hyperaldosteronism.
3. Urea and creatinine: High levels suggest a degree of renal impairment due to hypertension, or that underlying renal disease is the cause for hypertension.
4. Lipid and glucose concentrations: To judge cardiovascular risk status for each patient.
5. ECG: Detection of left ventricular hypertrophy and strain pattrn is an important adverse prognostic indicator.

2. Special tests: criteria for hypertension

1. Intravenous pyelogram and renal ultrasound, if renal disease is present.
2. Renal arteriography for renal artery stenosis
3. Plasma rennin activity and aldosterone for Conn syndrome
4. Angiography  /  MRI for coarctation of aorta.

Treatment Criteria For Hypertension

Management Criteria For Hypertension

Nonpharmacological Treatment

1. Salt restriction: Modest sodium restriction 2.4 gm sodium or 6 gm NaCl is effctive in controlling hypertension.

2. Weight reduction: In overweight persons, reduction of 1 kg may reduce 1.6 to 1.3 mm Hg of blood pressure

3. Stop smoking: Smoking raises BP. It is an independent and most important reversible coronary risk factor.

4. Diet: Lacto­vegetarian diet and high intake of poly unsaturated fih oils have high potassium levels and lower blood pressure by:

1. Increased sodium extraction
2. Decreased sympathetic activity
3. Decreased rennin­angiotensin secretion and direct dilatation of removal of renal arteries
4. Adequate calcium and magnesium intake should be maintained in diet

5. Limit of alcohol intake is done

6. Various forms of relaxation like yoga, biofeedback and psychotherapy lower the blood pressure

7. Regular exercise, relaxation exercise.

Pharmacological Therapy Criteria For Hypertension

1. Diuretics: Commonly used diuretics are hydrochlorothiazide 100 mg per day, chlorthalidone 50–100 mg/day.
The reduced potassium levels in body results in hypokalemia, potassium supplements have to be given in people on long­term diuretic therapy.
Potassium sparing diuretics, i.e. spironolactone 25 mg TDS is given.

2. Beta-blockers: Propranolol was used extensively as effctive antihypertensive drug. The dose administered as 40–160 mg/day.

3. Calcium channel blockers: Nifedipine 16 to 20 mg BD is administered. Side effects are headache, dizziness, flshing.
Drug is contraindicated in acute myocardial infarction, cardiogenic shock, pregnancy and is used with caution in diabetics and edema.
Felodipine sulfate 5 to 10 mg/day is effctive in mild to moderate hypertension.
Amlodipine 5 to 10 gm is effective and is safe in hypertensives.

4. ACE inhibitors:

1. Enalapril maleate 5 mg OD is given.
2. Captopril in combination with diuretics or a betablocker. 25 gm TDS of captopril is administered. It is considered safe in asthmatics and diabetics.
3. Ramipril 2.5 mg daily is used to reduce hypertension.

5. Alpha-1 adrenergic blockers: Prazosin is commonly used drug. Dose is 0.5 mg TDS.

6. Vasodilators: Diazoxide and sodium nitroprusside are given as IV dosage