What does jnc 7 mean

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Log in. Interested in AAFP membership? Learn more. Lee Green, M. Address correspondence to Lee Green, M. Reprints are not available from the author.

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Get Permissions. Read the Issue. Sign Up Now. Previous: Newsletter. Treating risk, not disease, means treating all patients with essential hypertension in the same way.

As noted by Deary et al, 26 in the clinical universe of essential hypertension we usually do not know the cause, but that does not mean that universe may not contain a basket of relatively discrete oligogenic syndromes. The powerful arguments for this second mechanistic approach call for strategies optimizing antihypertensive monotherapy based on an understanding of the renin-angiotensin system.

Any additional expense caused by increased office visits and N -of-1 trials at the start can be more than made up for by a more effective drug regimen throughout a lifetime. Lessons from treatment responses in hypertension in which the cause is known suggests that the height of the BP bears little relation to the need for combination therapy.

Initial combination therapy is arguably rational but is certainly not evidence based. Its rationale is merely that most patients end up on two drugs anyway. But the therapeutic sequencing upon which that sad fact is based was not rational to begin with. A tautology hardly forms a powerful logical basis for making a sad fact a rule.

In the section on identifiable causes of hypertension, the diagnostic test recommended for the diagnosis of primary hyperaldosteronism is a h urinary aldosterone excretion rate UAER.

This recommendation misleads doctors because UAER cannot distinguish between the rare primary and the common secondary forms. The PRA is critical because it is high in secondary hyperaldosteronism and is suppressed in primary hyperaldosteronism.

But JNC 7 never mentions renin. Such an omission is scientifically inexplicable. In the same section, the diagnosis of renovascular hypertension RVH is defined only in terms of the anatomic diagnosis of renal artery stenosis. Harry Goldblatt's research and a huge scientific literature. Many patients with anatomic renal artery stenosis do not have hypertension.

For that, one must measure PRA and, when necessary, renal venous renin, with appropriate consideration for the effects of drugs, renal dysfunction, comorbidity, and the distinctions between unilateral and bilateral disease on the sensitivity and specificity of the measurements.

In the section on hypertensive crisis, classic clinical taxonomy is replaced by a scheme based on triage. This negates relating treatment to any known pathophysiologic mechanisms. Both patients are pathophysiologically very different and should not be treated the same way. What do all of the above criticisms have in common? They all question the misguided effort of JNC 7 to simplify the treatment of hypertension, to make it easy, fast, and cheap. One cannot ignore malignant hypertension, curable with monotherapy, and not have patients suffer consequences.

One cannot ignore decades of research on Goldblatt hypertension and the role of renin release in renovascular hypertension and not mistreat renal artery stenosis. One cannot diagnose primary hyperaldosteronism without understanding the science of hormonal biofeedback and renin suppression. The JNC 7 ignores the science in hypertension for the sake of statistical simplicity. Why write this critique now? An erroneous conclusion, propagandized authoritatively by admired governmental advisory bodies, can carry the same weight as a sound one.

Therefore I have, for the record, probed misleading elements in the data and flaws in the JNC 7 logic used to reach questionable conclusions. If we ignore pathophysiology to make treating BP simple, we fail to honor our covenant with patients to provide each with the best possible care.

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Chobanian AV et al. JAMA May 21; Psaty BM et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: A network meta-analysis. Kottke TE et al. JNC 7 -- It's more than high blood pressure.

JAMA May 21 Physicians and patients alike should pay more attention to controlling blood pressure at the newly defined "prehypertensive" stage. Comment Thomas L.