The Joint National Committee on prevention, detection, evaluation, and treatment of high blood pres
The Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure
Although multiple specialty societies and consensus panels have made recommendations about the evaluation and treatment of hypertension, the JNC report has become the most frequently cited set of recommendations. What does the JNC report say about patients with severely elevated but asymptomatic high blood pressure? The sixth report of the JNC stated that “Elevated blood pressure alone, in the absence of symptoms or new or progressive target organ damage, rarely requires emergency therapy”. In addition, the JNC-7 report states that patients who have severely elevated blood pressure in the absence of end-organ damage “usually do not require hospitalization, but should receive immediate combination oral antihypertensive therapy”. This recommendation is consensus based and seems to indicate that outpatient treatment is appropriate.
When dealing with elderly patients who have severely elevated blood pressures, the primary care physician also must take into account medical conditions that can be aggravated by the presence of uncontrolled hypertension, such as congestive heart failure. Also, many physicians are not comfortable “doing nothing” for patients who have blood pressures in excess of 180/120 mm Hg. The JNC report recommends that patients who have severely elevated blood pressures be prescribed antihypertensive agents and followed closely. No recommendation is made for the acute reduction of blood pressure in any setting. Therefore, despite blood pressure numbers that are quite alarming, the primary care provider should remember that there is a clear lack of evidence that acute reductions change morbidity or mortality and that there is well-documented potential harm in rapidly lowering someone’s blood pressure.
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Robert L. Rogers MD, FAAEM, FACEP, FACP and Robert S. Anderson, Jr. MD
Department of Emergency Medicine, The University of Maryland School of Medicine, 110 South Paca Street, Suite 200, 6th floor, Baltimore, MD 21201, USA
Department of Medicine, The University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA