Managing multiple cardiovascular risk factors

Journal of Family Practice,  March, 2008  by Roy C. Blank,  Stephen Brunton

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TABLE 1
JNC 7 classification and management of blood pressure

Category          SBP (a)         DBP (a)         Lifestyle
                  (mm Hg)         (mm Hg)         Modification

Normal            <120            and <80         Encourage

Prehypertension   120-139         or 80-89        Yes

Stage 1           140-159         or 90-99        Yes
Hypertension

Stage 2           [greater than   or [greater     Yes
Hypertension      or equal to]    than or equal
                  160             to] 100

                  Considerations for Initial Therapy

Category          Without Compelling         With Compelling
                  Indications                Indications

Normal            No antihypertensive        Drug(s) for
                  drugs indicated            compelling
                                             indications (c)

Prehypertension

Stage 1           Thiazide-type diuretics    Drug(s) for
Hypertension      for most. May consider     compelling
                  ACEI, ARB, BB, CCB,        indications (c)
                  or combination

Stage 2           2-drug combination for     Other antihypertensive
Hypertension      most (usually thiazide-    drugs (diuretics,
                  type diuretic and ACEI     ACEI, ARB, BB,
                  or ARB or BB or CCB) (b)   CCB) as needed

ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin
receptor blocker; BB, beta-blocker; BP, blood pressure; CCB, calcium
channel blocker. DBP, diastolic blood pressure; SBP, systolic blood
pressure.

(a) Treatment determined by highest BP category.

(b) Initial combined therapy should be used cautiously in those at risk
for orthostatic hypotension.

(c) Treat patients with chronic kidney disease or diabetes to BP goal
of <130/80 mm Hg.

Chobanian AV, Bakris GL, Black HR, et al, for 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: the JNC 7 report. JAMA.
2003;289:2560-2572.

TABLE 2
JNC 7 compelling indications for specific antihypertensive agents based
on favorable outcomes data from clinical trials

                    Diuretic    Beta-      Angiotensin-     Angiotensin
                               Blocker      Converting        Receptor
                                         Enzyme Inhibitor     Blocker

CHF                 [check]    [check]       [check]          [check]
Post-MI                        [check]       [check]
CAD Risk            [check]    [check]       [check]
Diabetes Mellitus   [check]    [check]       [check]          [check]
Renal Disease                                [check]          [check]
Recurrent Stroke    [check]                  [check]
Prevention

                    Calcium Channel   Aldosterone
                        Blocker        Antagonist

CHF                                     [check]
Post-MI                                 [check]
CAD Risk                [check]
Diabetes Mellitus
Renal Disease
Recurrent Stroke
Prevention

CAD, coronary artery disease; CHF, congestive heart failure; MI,
myocardial infarction.

Chobanian AV, Bakris GL, Black HR, et al, for 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: the JNC 7 report. JAMA.
2003;289:2560-2572.

TABLE 3
Summary of treatment goals for blood
pressure, lipids, and blood glucose

                 Goal

Blood Pressure   <140/90 mm Hg (<130/80 mm Hg in
                 patients with diabetes or chronic
                 kidney disease)

LDL-C            <100 mg/dL (<70 mg/dL optional in
                 high-risk patients)

Blood Glucose,   <7% in general (as close to 6% as
HbA1c            possible without significant
                 hypoglycemia for individual patients)

HbA1 c, glycosylated hemoglobin; LDL-C, low-density
lipoprotein cholesterol.

Chobanian AV, et al, for the National High Blood
Pressure Education Program Coordinating Committee.
JAMA. 2003;289:2560-2572.

Grundy SM, et al, for the Coordinating Committee of the
National Cholesterol Education Program. Circulation.
2004;110;227-239.

American Diabetes Association. Diabetes Care. 2007;
30(suppl 1):S4-S41.

COPYRIGHT 2008 Dowden Health Media, Inc.
COPYRIGHT 2008 Gale, Cengage Learning