The AHA Guidelines and Scientific Statements Handbook

Chapter 11 Hypertension

In 2003 the Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure – JNC 7 [1,2]
was published. The following contains extracts from
that report and a summary of some of the major
recommendations. Note that these recommenda-
tions are 5 years old, and there have been many
advances in hypertension research and treatment
that warrants an update.
Hypertension, as defi ned by JNC 7 [1,2] as a sys-
tolic blood pressure (SBP) ≥140 mm Hg, or a dia-
stolic blood pressure (DBP) ≥90 mm Hg, and/or
current use of antihypertensive medication, affects
more than 65 million adult individuals in the United
States [10], nearly one-third of the adult population,
and approximately 1 billion individuals worldwide.
Another one-quarter of US adults have “pre-
hypertension,” a SBP of 120–139 mm Hg or DBP of

80 to 89 mm Hg, that is a level above normal but

below the hypertensive range. As the population

ages, the prevalence of hypertension will increase

even further unless broad and effective preventive

measures are implemented.

The relationship between BP and risk of cardio-

vascular disease (CVD) events is continuous, consis-

tent, and independent of other risk factors. The

higher the BP, the greater the chance of myocardial

infarction, heart failure (HF), stroke, and kidney

disease. Data from observational studies involving

more than 1 million individuals [11] show a pro-

gressive and log-linear relationship between BP and

death from ischemic heart disease or stroke, and this

relationship is robust from BP levels as low as

115 mm Hg systolic and 75 mm Hg diastolic and

upward, and in all age groups from 40 to 89 years

old. For every 20 mm Hg systolic or 10 mm Hg dia-

SBP DBP

IHD Mortality

(Floating Absolute Risk, 95% CI)

256

128

64

32

16

8

4

2

1

120 140 160 180

Usual SBP (mm Hg)

256

128

64

32

16

8

4

2

1

70 80 90 100 110

Usual DBP (mm Hg)

IHD = ischemic heart disease; CI = confidence interval.

40–49

50–59

60–69

70–79

80–89

Age at Risk (y)

Ischemic heart disease mortality rate in each decade of age versus

usual blood pressure at the start of that decade

Fig. 11.1 Ischemic heart disease (IHD) mortality rate in each decade of age versus usual blood pressure at the start of that decade.
Reprinted with permission from Lewington et al. Lancet. 2002;360:1903–1913.