Recommendations Summary

HTN: Management of Blood Pressure 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  HTN: Comprehensive Program for Blood Pressure Management

  Management of elevated blood pressure should be based on a comprehensive program including lifestyle modification (weight reduction, medical nutrition therapy and physical activity) and pharmacologic therapy. Research indicates that a comprehensive program can prevent target organ damage and improve cardiovascular outcomes.

  Rating: Consensus
  Imperative

  • Risks/Harms of Implementing This Recommendation

    Adverse side effects may be observed in some patients receiving pharmacologic therapy.

  • Conditions of Application

    • Based on the JNC 7 report, all people with hypertension (stages 1 and 2) should be treated.
    • Based on the JNC 7 report, compelling indications for specific pharmacotherapy include heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, and recurrent stroke prevention.

  • Potential Costs Associated with Application

    • The cost of medications may be a barrier to effective treatment.
    • Patients should be advised that most lifestyle modifications, such as smoking cessation, reduction of alcohol consumption, and the DASH dietary pattern, may be cost effective, as well as reduce the amount and cost of medications and insurance.

  • Recommendation Narrative

    • In the JNC 7 report, failure to prescribe lifestyle modifications, adequate antihypertensive drug doses, or appropriate drug combinations may result in inadequate blood pressure control.
    • In the JNC 7 report, although blood pressure control can be achieved in some patients who are hypertensive, the majority will require two or more antihypertensive drugs.

  • Recommendation Strength Rationale

    The ADA Hypertension Expert Work Group concurs with the recommendations from the JNC 7,  regarding management of blood pressure.

    • Updated from The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Arch Intern Med 1997; 157:2413-46.
    • Published in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.  JAMA 2003;289:2560-71.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    The Seventh Report of the Joint National Commitee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, NIH Publication No. 04-5230, August 2004, produced by the National Heart, Lung and Blood Institute in cooperation with the National High Blood Pressure Education Program.

    Available at:   

    http://www.nhlbi.nih.gov/guidelines/hypertension/

    To access the pdf of the JNC 7, click here: 

    http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm