Millions of patients are not at JNC 7 BP goal.
The National Health and Nutrition Examination Survey (NHANES) found that millions of hypertensive patients are not at blood pressure (BP) goal after antihypertensive treatment. (1) Specifically, more than 5 out of 10 treated hypertensive patients are not where they need to be in terms of BP control. (1)
Many hypertensive patients who are not at goal can be characterized by lifestyle, economic situation, race, gender, body type, age, and/or disease state. (1,2) In African Americans, hypertension is more common, more severe, develops at an earlier age, and tends to be more poorly controlled than in Caucasians. Mexican Americans and Native Americans have even lower control rates than Caucasians and African Americans. (2) Hypertension is disproportionately higher in diabetics than nondiabetics, and the vast majority of patients with metabolic syndrome are considered prehypertensive or hypertensive. (2) In addition, patients over 60 years old are the most rapidly growing segment of the population and the prevalence of isolated systolic hypertension increases with age. (2) And for women in their 60s, the prevalence of hypertension is equal to or exceeds males of the same age. (2)
Percentage of Treated Hypertensive Patients Not at Goal (1) African Americans 55% Hispanics 56% Caucasians 44% Patients [greater than or equal to]60 years old 56% Patients with diabetes 75%
A Major Study Indicates Current Therapies Fail to Get Many Patients to BP Goal (ALLHAT) (3)
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial found that patients often did not reach goal on certain antihypertensive regimens. Regimens used in this trial were an ACE inhibitor-based regimen (lisinopril), CCB-based regimen (amlodipine), and diuretic-based regimen (chlorthalidone). (3)
Percentage of patients not Mean number of BP achieving goal at 1 year medications at year 1 ACE inhibitor-based 49% 1.5 regimen (3) (lisinopril) CCB-based regimen (3) 45% 1.4 (amlodipine) Diuretic-based 42% 1.4 regimen (3) (chlorthalidone) Note: Table made from bar graph.
JNC 7 Continues to Set Aggressive Goals (2)
The challenge of getting hypertensive patients to BP goal remains crucial. The targeted BP goal for hypertensive patients is <140/90 mm Hg. (2) In hypertensive patients with diabetes or chronic kidney disease, the goal is now even lower at <130/80 mm Hg. (2) With aggressive goals comes the need for more aggressive treatment: JNC 7 acknowledges 2/3 of hypertensive patients will require 2 or more medications to be controlled. (2)
* 2/3 of hypertensive patients will require 2 or more medications to be controlled (2)
* JNC 7 BP goal is <140/90 mm Hg; BP goal in hypertensive patients with diabetes or chronic kidney disease is <130/80 mm [Hg.sup.2]
Attaining and Maintaining BP Goal Has Never Been More Important
JNC 7 recognizes hypertension--as well as numerous other factors--as a major risk factor for CVD. (2)
Updated JNC 7 Cardiovascular Risk Factors (1)
* Age (>55 for men, >65 for women)
* Diabetes mellitus
* Microalbuminuria or estimated GFR <60 mL/min
* Family history of premature CVD (women <65 or men <55)
* Obesity (BMI >30 kg/[m.sup.2])
* Physical inactivity
* Cigarette smoking
New Treatment Strategies Are Critical
JNC 7 has stipulated that both SBP and DBP goals need to be reached for hypertensive patients to be considered adequately controlled, so treatment selection is important. As stated previously, JNC 7 predicts the majority of patients will ultimately require more than monotherapy to reach goal. (2) This should also be a consideration when deciding the optimal course of disease management for patients.
References: 1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290:199-206. 2. Chobanian AV, Bakris GL, Black HR, et al, and the National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7-Complete Version. Hypertension. 2003;42:1206-1252. 3. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-2997.
Bristol-Myers Squibb Sanofi-Synthelabo Partnership
[c] 2005 Bristol-Myers Squibb Sanofi-Synthelabo Partnership
Sanofi-Synthelabo Inc., a member of the sanofi-aventis Group
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|Publication:||Internal Medicine News|
|Date:||Jul 1, 2005|
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