The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure<SUBTITLE>The JNC 7 Report</SUBTITLE>
Abstract
"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.
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Elevated apoB-containing lipoproteins, low HDL-C levels, and hypertension are well-established major risk factors.
“Indeed, 3 of the metabolic risk factors-elevated apoB-containing lipoproteins, 1 low HDL-C levels, 1 and hypertension 91 -are well established, major risk factors.”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
For overt hypertension without diabetes or chronic kidney disease, the antihypertensive goal is blood pressure below 140/90 mm Hg.
“When overt hypertension is present without diabetes or chronic kidney disease, the goal for antihypertensive therapy is a blood pressure of Ͻ140/90 mm Hg. 91”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
The benefits of therapy extend to patients with type 2 diabetes whose blood pressure is above goal, and presumably to hypertensive patients with metabolic syndrome.
“The benefits of therapy extend to patients with type 2 diabetes mellitus whose blood pressure is above goal level, and presumably to hypertensive patients with the metabolic syndrome.”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
Mild blood pressure elevations can often be controlled effectively with lifestyle therapies: weight control, increased physical activity, alcohol moderation, sodium reduction, and more fruits, vegetables, and low-fat dairy, consistent with the DASH diet.
“Mild elevations of blood pressure often can be effectively controlled with lifestyle therapies: weight control, increased physical activity, alcohol moderation, sodium reduction, and increased consumption of fresh fruits and vegetables and low-fat dairy products, in accord with the Dietary Approaches to Stop Hypertension (DASH) diet.91”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
With diabetes or chronic kidney disease, the blood pressure goal is below 130/80 mm Hg.
“In the presence of diabetes or chronic kidney disease, the blood pressure goal is Ͻ130/80 mm Hg. 91”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
For patients with established type 2 diabetes, clinical trials confirm that treating dyslipidemia and hypertension reduces cardiovascular risk.
“For patients with established type 2 diabetes mellitus, clinical trials confirm a reduction in cardiovascular risk from treatment of dyslipidemia 161-163,179 -181 and hypertension.91”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [91]
Assiduous attention to abnormalities other than hyperglycemia that accompany type 2 diabetes, such as hypertension and dyslipidaemia, has been shown to improve microvascular and cardiovascular complications.
“Assiduous attention to abnormalities other than hyperglycemia that accompany type 2 diabetes, such as hypertension and dyslipidaemia, has been shown to improve microvascular and cardiovascular complications.”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [22]
For hypertension diagnosis, the included studies generally reported uniform criteria based on levels of SBP >140 mmHg and/or DBP >90 mmHg or use of anti-hypertensive medication.
“For hypertension diagnosis, the studies generally reported more uniformed criteria based on levels of SBP > _140mmHg and/or DBP > _90 mmHg or use of anti-hypertensive medication.41”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [41]
Measurement and treatment of blood lipids, blood pressure, and glucose levels have become the major emphases for cardiovascular risk reduction.
“Nevertheless, measurement and treatment of blood lipids, blood pressure, and glucose levels have became the major emphases for cardiovascular risk reduction.”
From Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease (2008) · cites this paper as [24]
Following a healthful eating plan can reduce several recognized risk factors for cardiovascular diseases.
“there is good evidence that following a healthful eating plan can reduce several of the recognized risk factors for cardiovascular diseases.”
A nutritionally balanced diet plays an important role in maintaining a healthy weight and can have a favorable impact on blood pressure and plasma lipids.
“good evidence indicates that a nutritionally balanced diet plays an important role in maintaining a healthy weight and can have a favorable impact on blood pressure 12 and plasma lipids.93”
Only about 34% of individuals with hypertension are on medication and have well-controlled blood pressure; 25% are on medication but have inadequate blood pressure control.
“Only about 34% are on medication and have wellcontrolled blood pressure; 25% are on medication but have inadequate blood pressure control.12”
An estimated 30% of those with hypertension are unaware that they have it.
“The prevalence of hypertension is increasing, and an estimated 30% of those with hypertension are unaware that they have it.12”
Elevated blood pressure is associated with a 2 to 3 times higher risk of developing congestive heart failure and substantially increases the risk of stroke, with blood pressures of 160 mm Hg systolic and/or 90 mm Hg diastolic or greater associated with a relative risk of stroke estimated at 4 times greater than in individuals without hypertension.
“Elevated blood pressure is associated with a 2 to 3 times higher risk of developing congestive heart failure and substantially increases the risk of stroke, with blood pressures of 160 mm Hg systolic and/or 90 mm Hg diastolic or greater associated with a relative risk of stroke that has been estimated at 4 times greater than in individuals without hypertension.”
The prevalence of hypertension is increasing.
“The prevalence of hypertension is increasing, and an estimated 30% of those with hypertension are unaware that they have it.12”
Approximately 1 in 4 American adults has high blood pressure, defined as systolic pressure ≥140 mm Hg or diastolic pressure ≥90 mm Hg.
“Approximately 1 in 4 American adults has high blood pressure, defined as systolic pressure Ն140 mm Hg or diastolic pressure Ն90 mm Hg. 12”
There are important disparities in the prevalence of hypertension, with blacks developing elevated blood pressure at an earlier age and having higher pressures on average.
“There are important disparities in the prevalence of hypertension, with blacks both developing elevated blood pressure at an earlier age and having higher pressures on average.”
The diagnostic cutoff for hypertension is lower in people with diabetes (blood pressure ≥130/80) than in those without diabetes (blood pressure ≥140/90 mmHg).
“Because of the clear synergistic risks of hypertension and diabetes, the diagnostic cutoff for a diagnosis of hypertension is lower in people with diabetes (blood pressure ≥130/80) than in those without diabetes (blood pressure ≥140/90 mmHg) (160).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
Studies in nondiabetic individuals have shown anti-hypertensive effects similar to pharmacologic monotherapy of reducing sodium intake and excess body weight; increasing consumption of fruits, vegetables, and low-fat dairy products; avoiding excessive alcohol consumption; and increasing activity levels.
“Although there are no well-controlled studies of diet and exercise in the treatment of hypertension in individuals with diabetes, studies in nondiabetic individuals have shown anti-hypertensive effects similar to pharmacologic monotherapy of reducing sodium intake and excess body weight; increasing consumption of fruits, vegetables, and low-fat dairy products; avoiding excessive alcohol consumptio”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in individuals with diabetes.
“Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in individuals with diabetes (160,163–165).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
Epidemiologic analyses show that blood pressure >115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes.
“Epidemiologic analyses show that blood pressure >115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes (160,166,167).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
Other studies have shown no specific advantage to ACE inhibitors as initial treatment of hypertension in the general hypertensive population, but rather an advantage on cardiovascular outcomes of initial therapy with low-dose thiazide diuretics.
“However, a variety of other studies have shown no specific advantage to ACE inhibitors as initial treatment of hypertension in the general hypertensive population, but rather an advantage on cardiovascular outcomes of initial therapy with low-dose thiazide diuretics (160,172,173).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
Many patients will require three or more drugs to reach target blood pressure goals.
“Many patients will require three or more drugs to reach target goals (160).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [160]
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Standards of Medical Care in Diabetes—2008
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on behalf of the NN8022-1923 Investigators, Wadden, T. A., Hollander, P., Klein, S., Niswender, K., Woo, V, Hale, P. M., & Aronne, L. (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.120 · Cited by 842 · see citing works
- Authors
- Chobanian, A. V.
- Affiliations
- Boston University (US)
- Corresponding author
- Chobanian, Aram V.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-05-21
- Volume
- 289
- Issue
- 19
- Pages
- 2560
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2156121263
- Cited by
- 25,386
- References
- 59
- Citations by year
- 2026: 169 · 2025: 261 · 2024: 358 · 2023: 377 · 2022: 499 · 2021: 608 · 2020: 697 · 2019: 731 · 2018: 808 · 2017: 866 · 2016: 976 · 2015: 1323 · 2014: 1629 · 2013: 1747 · 2012: 1747
- FWCI
- 912.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- hypertension, JNC 7 guidelines, blood pressure targets, systolic blood pressure, cardiovascular risk, prehypertension, thiazide diuretics, combination antihypertensive therapy, ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, patient motivation, physician-patient trust, lifestyle modification, diabetes mellitus, chronic kidney disease
- MeSH terms
- Adrenergic alpha-Agonists, Adrenergic alpha-Antagonists, Algorithms, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Calcium Channel Blockers, Cardiovascular Diseases, Diagnostic Tests, Routine, Diuretics, Humans, Hypertension, Risk Factors, Vasodilator Agents, Blood Pressure Monitors, Risk Reduction Behavior, Angiotensin Receptor Antagonists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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