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Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials.

The recent publication in Hypertension of the complete version of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) provides clinicians and scientists with a valuable resource.1 For the first time, the National Heart, Lung, and Blood Institute (NHLBI)-sponsored National High Blood Pressure Education Program Coordinating Committee presented the national blood pressure guidelines in two forms. The express version, published May 2003, was designed as a succinct guide for the busy primary care clinician.2 The complete version provides the scientific basis, rationale, extensive figures and charts, and references to support the JNC 7 recommendations. The complete version will be of value to specialists, academicians, scientists, and clinicians who seek the evidence that bolsters the report’s recommendations.

There was a 6-year hiatus since JNC 6 was published, which is a much longer interval than that of previous reports. This was partially because of the anticipation of the completion of several important new clinical trials and epidemiology studies. The announcement of the formation of the writing committee for JNC 7 closely followed the publication of results of the NHLBI-sponsored Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study.3

JNC 7 streamlined the classification of blood pressure and introduced the term “prehypertension,” which has received much attention. Prehypertension replaces the older terms of “normal” and “high normal,” which suggested complacency and that little action was needed. The term is used to encourage clinicians and patients to take this level of blood pressure more seriously. The recommendation to begin lifestyle therapy at such low blood pressures is based on strong epidemiological data indicating that the risk associated with blood pressure begins at or below these levels.1

This new concept of prehypertension is, indeed, important. However, the clear …