Manual of Clinical Nutrition

Hypertension

Manual of Clinical Nutrition Management III- 63 Copyright © 2013 Compass Group, Inc.

Table III- 14 : JNC 7 Classification and Management of Blood Pressure for Adults (6)
Blood Pressure
Classification

Systolica^

(mm Hg)

Diastolica

(mm Hg)

Lifestyle

Modification

Drug Therapy

With No Medical

Conditions

Drug Therapy With
Existing Medical
Conditionsb
Normal <120 and <80 Encourage Not indicated Not indicated
Prehypertension 120 - 139 or 80- 89 Yes Not indicated Indicated in cases of
diabetes or kidney
diseasec
Stage 1
hypertension

140 - 159 or 90- 99 Yes Thiazide-type

diuretics for

most patients

Consider ACEI,

ARB, BB, CCB, or

combination

Drugs specific for
medical conditions
Other antihypertensive
drugs (diuretics,
ACEI, ARB, BB, CCB)
as needed
Stage 2
hypertension

>160

or >100

Yes Two-drug

combination for

mostd patients

(thiazide-type

diuretic and

ACEI, ARB, BB, or

CCB)

Drugs specific for

medical conditions

Other antihypertensive

drugs (diuretics,

ACEI, ARB, BB, CCB)

as needed

ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta blocker; CCB, calcium channel blocker
aTreatment is determined by highest blood pressure category.
bMedical conditions include: heart failure, postmyocardial infarction, high risk of coronary disease, chronic kidney disease, and recurrent
stroke prevention.
c Treat patients who have chronic kidney disease or diabetes to achieve the blood pressure goal of <130/80 mm Hg.
d Initial combined therapy should be used cautiously in patients at risk for orthostatic hypotension.

Evaluation
According to the JNC 7, the evaluation of patients with documented hypertension has three objectives (2): 1)
assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that affect prognosis
and guide treatment, 2) reveal identifiable causes of high blood pressure (refer to Table III- 1 5), and 3) assess
the presence or absence of target organ damage and cardiovascular disease.

Table III- 15 : Causes of Hypertension (2)
Sleep apnea
Drugs such as cyclosporine, nonsteroidal anti-inflammatory drugs, sympathomimetics (decongestants,
anorectics), oral contraceptive hormones, adrenal steroid hormones, and erythropoietin
Herbal supplements such as ephedra (ma huang) and bitter orange
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Chronic steroid therapy and Cushing’s syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease

Causal factors for hypertension include excess body weight; excess dietary sodium intake; reduced physical
activity; inadequate intake of fruits, vegetables, and potassium; and excess alcohol intake (1,7,8). According to
the JNC 7, the prevalence of these characteristics is high. Recent data indicate that 64% of American adults
are either overweight or obese (9). Mean sodium intake is 4,100 mg/day for men and 2,750 mg/day for
women. The consumption of processed foods accounts for 75% of the daily sodium intake (2). Fewer than
20% of Americans engage in physical activity (10), and fewer than 25% consume five or more servings of fruits
and vegetables daily (11).

Nutritional Assessment and Evaluation
Routine nutritional assessment should include blood pressure evaluation (Grade IV)* (12); assessment for signs of
edema; and review of laboratory tests that assess blood glucose, hematocrit, serum potassium, calcium,
creatinine or glomerular filtration rate, and lipid profiles (2). The patient’s height and weight should be
measured, and the patient’s body mass index should be evaluated to assess the need for weight management