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Hypertension JNC 7 Guidelines
The Seventh Report of theJoint National Committee on Prevention
www.nhlbi.nih.gov/guidelines/hypertension
Jeffrey Beal, M.D.
Clinical Director, Florida/CaribbeanAIDS Education and Training Center
AAHIVMS
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Disclosure of Financial Relationships
Speakers Bureau: Bristol-Myers Squibb, Glaxo
This slide set has been peer-reviewed to ensure that there are no conflicts of
interest represented in the presentation.
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All of the following are key
messages from JNC 7 except:1. Systolic BP > 140 mmHG is a much more
important CVD risk factor than diastolic BP in
persons >50 y/o2. The risk of CVD beginning at 115/75 mmHg
doubles with each increment of 20/10 mmHg
3. Thiazide-type diuretics are rarely indicated in
the treatment of hypertension4. Goal blood pressure for hypertensive patients
is
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Which of the following is incorrect for the
proper measurement of BP in the officesetting?
1. Persons should be seated for at least 5
minutes resting before taking the BP
2. BP should be taken with the patient sitting onexam table with the arm relaxed in their lap
3. At least 2 measurements should be made
4. SBP is the point at which the first of two ormore sounds is heard
5. DBP is the point before the disappearance of
sound (phase 5)
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Normal blood pressure is
defined in JNC 7 as:1.
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JNC 7 Classification of BP1. Normal BP = < 120/80
2. Prehypertension = 120-139/80-893. Stage 1 HTN = 140-159/90-99
4. Stage 2 HTN = 160/100
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Of the following lifestyle modifications, which
has the greatest potential reduction in SBP?
1. Weight loss to normal body weight (BMI
18.5-24.9 kg/m2)
2. Adopting the DASH eating plan
3. Dietary sodium restriction
4. Physical activity5. Moderation of alcohol intake
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Recommendation SBP Reduction
Maintain normal body weight
(BMI 18.5-24.9 kg/m2)
5-20 mmHg/10 kg weight
loss
Diet rich in fruits, vegetables,
& fat dairy products with
reduced saturated and total fat
8-14 mmHg
Sodium to
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Management of Hypertension 60 y/o HIV positive Black female has initial
and 3 subsequent office visits with
elevated BP by nurse Blood pressure 140/96, repeated 5
minutes later 142/92
Patient assessed as Stage 1 HTN
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CV Risk Factors HTN
Cigarette Smoking Obesity: Weight 220lbs, height 56 = BMI35.5
Physically Inactive Dyslipidemia: Chol, HDL, Nl LDL/Trig.
Diabetes mellitus
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CV Risk Factors Microalb. or Estimated GFR 55 for, > 65 FH premature CV disease (
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Physical Exam BP equivalent in both arms
Grade II KW changes on funduscopic Waist circumference >40 , >35 (pt.42)
No carotid, abdominal, femoral bruit
Nl thyroid palpation, heart, lung andabdomen exam, lower ext. pulses, and
neurologic exam
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Lab/other diagnostic ECG mild LVH
UA, Glucose, Hct., serum K+
, Creatinine,Ca++, Triglycerides normal
Chol. 230 mg/dL, HDL 30 mg/dL, LDL 88mg/dL
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Identifiable Causes of HTN Sleep apnea
CKD
Primary aldosteronism (K+, fails HTN tx.) Renovascular ds.
Chronic steroids/Cushings syndrome
Pheochromocytoma Coarctation of aorta
Thyroid/Parathyroid disease
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Medications Causing HTN NSAID, especially Cox-2 inhibitors Cocaine, amphetamine, other illicit drugs
Sympathomimetics (decongestants, anorectics) Oral contraceptives Adrenal steroids Cyclosporine and tacrolimus
Erythropoietin Licorice (including some chewing tobacco) OTC (ephedra, ma haung, bitter orange)
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Lifestyle Modification Lifestyle modification education done
Weight loss and exercise
Low Na++, DASH diet
Low fat diet
Patient never drinks more than 4 oz. wine,2-3 meals per week
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Patient Concomitant Medication Atazanavir 300 mg + Ritonavir 100 mg +
Truvada
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What medication(s) would you
start?1. Diuretic therapy
2. ACE Inhibitor3. Angiotensin receptor blocker
4. Beta-blocker
5. Calcium channel blocker6. Diuretic plus one of the above
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Generalizations for HTN/HIV No clinical studies to date with ARV
therapy and pharmacologic effect on
antihypertensive medications
Best to start with one drug and add usinglowest starting dose and increasing on at
least monthly visits if patient clinicallystable
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Antihypertensive Drugs Diuretics: no drug interactions
Beta Blockers:
Monitor prolonged PR interval ATV Ritonavir can increase BB levels
NNRTI can BB levels
ACE inhibitors and ARB
Varied effect
Calcium Channel Blockers In general levels increased
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