A review of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Hypertension is a major modifiable risk factor for cardiovascular diseases. After decades of improvement, population surveys demonstrate disturbing do wnward trends in the rates of awareness, treatment, and control of this dis order in recent years. Over this same time period, there has been a slight increase in the incidence of strokes, and a steady rise in the incidence of end-stage renal disease and the prevalence of congestive heart failure, co nditions in which hypertension plays a prominent role. Results of recent st udies support the possibility that lifestyle modifications may be effective for prevention of hypertension. Treatment of established hypertension invo lves lifestyle modifications and drug therapies designed to control blood p ressure and reduce overall cardiovascular risk. Both threshold blood pressu re levels for initiating drug therapy and goal blood pressure levels with t reatment are individually determined based on the presence or absence of ad ditional cardiovascular risk factors and hypertension target organ injury o r clinical cardiovascular disease. Recent clinical trials support the value of lower goat blood pressures for patients with diabetes, heart failure, a nd renal disease. The presence or absence of comorbid conditions often dete rmines specific drug choices. Diuretics and P-blockers remain the drugs of choice in uncomplicated hypertension. Additional studies confirm the benefi ts of treating isolated systolic hypertension in the elderly. The Sixth Rep ort of the Joint National Committee on Prevention, Detection, Evaluation, a nd Treatment of High Blood Pressure provides a practical, evidence-based re source to help health care providers meet the public health challenges of p reventing and controlling hypertension.