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National panel redraws blood pressure guidelines (11/25/97)

A national panel of experts on hypertension has issued a new report that reclassifies blood pressure categories and suggests a more liberal treatment philosophy for patients at high risk of heart disease and stroke who show "high normal" pressure readings.

The Sixth Report of the Joint National Commission on Detection, Evaluation and Treatment of High Blood Pressure (JNC VI) appeared in the Nov. 24 edition of *Archives of Internal Medicine*. Copies of the report are available on the Internet at:

Michael Jamieson, MD, assistant professor, division of clinical pharmacology, departments of pharmacology and medicine, at The University of Texas Health Science Center at San Antonio, served as a reviewer of the report and is acknowledged in the document. JNC reports represent the largest consensus view as to the contemporary, evidence-based management of hypertension in this country.

The new report adopts a revised classification of blood pressure levels, including a new category of "optimal" blood pressure. It recommends a strategy of risk stratification to determine the need for treatment, including a new recommendation to begin drug therapy in high-risk individuals with "high normal" blood pressure (130-139/85-89 mmHg).

"This panel of experts continues to recommend a thiazide-beta blocker-based, stepped-care approach for most patients, on the basis that the long-term benefits of these drugs are clear," Dr. Jamieson said. "The report also introduces a more liberal, tailored approach for patients with conditions such as diabetes and heart failure in which there are compelling arguments for using alternative first-line medications, such as the angiotensin-converting enzyme inhibitors.

"It also discusses other clinical circumstances in which co-morbid conditions (such as angina, dyslipidemia and prostatism) may justify the selection of alternative first-line drugs." A controversy over use of calcium channel blockers is discussed in detail, he noted.

Preventive therapy is stressed in the report, which also touches on the role of managed care, the cost of care, newer agents such as the angiotensin receptor antagonists, combination drug therapies, strategies for improving adherence of patients to therapeutic regimens, and the place of self-measurement of blood pressure.

Dr. Jamieson and Alexander M.M. Shepherd, MD, PhD, professor of pharmacology, provide hypertension consulting services at University Hospital and the South Texas Veterans Health Care System, a hypertension clinic on Wednesday afternoons at the University Health Center-Downtown and a clinic at the veterans system on Tuesday mornings.

"I would be very happy to answer any questions about JNC VI," said Dr. Jamieson, who can be reached at (210) 567-8533.

Contact: Will Sansom (210) 567-2570