Reference Card From the

Seventh Report of the Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High Blood Pressure ONC 7)

Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients

Normal <120 and <80 with diabetes or chronic kidney disease.
Majority of patients will require two medications to reach goal.
Prehypertension 120-139 or 80-89
Hypertension, Stage I 140-159 or 90-99
Hypertension , Stage 2 ",160 or ",100
See Blood Pressure Measurement Techniques (reverse side)

Key: SBP = systolic blood pressure DBP = diastolic blood pressure

Not at Goal Blood Pressure (<140/90 mmHg)

DIAGNOSTIC WORKUP OF HYPERTENSION 130180 mmHg for patients with diabetes or chronic kidney disease)

Assess risk factors and comorbidities.

See Strutegles (Dr Improving Adherence to Therupy
Reveal identifiable causes of hypertension.

Assess presence of target organ damage.

Conduct history and physical examination.

Obtain laboratory tests: urinalysis, blood glucose, hematocrit and lipid

panel, serum potassium, creatinine, and calcium. Optional: urinary

albumin/creatinine ratio.
Without Compelling
With Compelling

Obtain electrocardiogram.
Indications
Indications

ASSESS FOR MAJOR CARDIOVASCULAR DISEASE (CVD)

RISK FACTORS Drug(s) for the
Stage 1 Stage 2
Hypertension Physical inactivity Hypertension Hypertension compelling indications
Obesity Microalbuminuria. estimated (SBP 140-159 or DBP (SBP ~160 or DBP See Compelling
90'-99 mmHg) ~100 mmHg) Indications {or Individual
(body mass index .?,30 kg/m2) glomerular filtration rate <60 mUmin Drug Classes
Dysli pidemia Age (>55 for men, >65 for women) Thiazide-type diuretics 2-drug combination for
for most. May consider most (usually thiazide Other antihypertensive
Diabetes mellitus Family history of premature CVD
ACEI. ARB, BB. CCB. type diuretic and ACEI. drugs (diuretics, ACEI.
Cigarette smoking (men age <55 , women age <65) ARB, BB. CCB) as needed.
or combination. or ARB. or BB. or CCB).
ASSESS FOR IDENTIFIABLE CAUSES OF HYPERTENSION
Sleep apnea
Cushing's syndrome or steroid
Drug induced/related
therapy
Chronic kidney disease
Pheochromocytoma
Primary aldosteronism
Coarctation of aorta Optimize dosages or add additional drugs until goal blood pressure is
Renovascular disease
Thyroid/parathyroid disease achieved. Consider consultation with hypertension specialist.

/~ ' .."~~o"
See Strategies (Dr Impravlng Adherence to Therapy
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
f J~
\.>. ~"E. National
Nat io n al In stitu te s of Hea Ith
Heart . Lung . and Blood Institute
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 Encourage healthy lifestyles for all individuals.
In-office Two readings, 5 minutes apart, sitting in chair. Prescribe lifestyle modifications for all patients with prehypertension
Confinn elevated reading in contralateral ann. and hypertension.
Components of lifestyle modifications include weight reduction, DASH
Ambulatory BP monitoring Indicated for evaluation of "white coat hyper
eating plan, dietary sodium reduction, aerobic physical activity, and
tension." Absence of 10-20 percent BP
moderation of alcohol consumption.
decrease during sleep may indicate increased
CVD risk.
Patient self-check Provides infonnation on response to therapy.
May help improve adherence to therapy and is
useful for evaluating .. white coat hypertension. "
Weight I Maintain nonnal body weight 15-20 mmHg/I0 kg
reduction (body mass index 18.5-24.9
kg/m2) .
DASH eating Adopt a diet rich in fruits,
Improper BP measurement plan vegetables, and lowfat dairy 18-14 mmHg
Excess sodium intake products with reduced content
Inadequate diuretic therapy of saturated and total fat.
Medication
- Inadequate doses Dietary Reduce dietary sodium intake to
- Drug actions and interactions (e.g., nonsteroidal anti-inflarrunatory drugs sodium S100 rrunol per day (2.4 g sodi 12-8 rrunHg
(NSAIDs), illicit drugs, sympathornimetics, oral contraceptives)
reduction um or 6 g sodium chloride).
- Over-the-counter (OTC) drugs and herbal supplements
Aerobic Regular aerobic physical activi
Excess alcohol intake physical ty (e.g., brisk walking) at least 14-9 rrunHg
Identifiable causes of hypertension (see reverse side) activity 30 minutes per day, most days
of the week.
Moderation Men: limit to .s:2 dIinks* per day.
COMPELLING INDICATION INITIAL THERAPY OPTIONS Women and lighter weight per 12-4 rrunHg
of alcohol
Heart failure THIAZ, BB, ACEI, ARB, ALDO ANT consumption sons: limit to SI drink* per day.
Post myocardial infarction BB, ACEl, ALDO ANT
High CVD risk THIAZ, BB, ACEl, CCB *, drink = '/2 oz or '5 mL ethanol (e.g., '2 oz beer, 5 oz wine, '.5 oz 80-proof whiskey).
Diabetes THIAZ, BB, ACEI, ARB, CCB t Effects are dose and time dependent.
Chronic kidney disease ACEI, ARB
Recurrent stroke prevention THIAZ, ACEI
Key: THIAZ = thiazide diuretic, ACEI= angiotensin converting enzyme inhibitor, ARB = angiotensin receptor
blocker, B6 = beta blocker, CC6 = calcium channel blocker, ALDO ANT = aldosterone antagonist

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Clinician empathy increases patient trust, motivation, and adherence to therapy. National Institute s of Health

Physicians should consider their patients' cultural beliefs and individual attitudes National Heart, Lung, and Blood Institute

in fonnulating therapy. National High Blood Pressure Education Program

NIH Publication No . 03-5231

The National !-Ugh Blood Pressure Education Program is coordinated by the National Heart, Lung, and May 2003
Blood Institute (NHLBU at the National Institutes of Health. Copies of the JNC 7 Report are available on
the NHLBI Web site at hnp://www.nhIbl.nIh.gov or from the NHLBI Health Infonnation Center. P.O. Box
30105 , Bethesda, MD 20824-0105; Phone: 301-592-8573 or 240-629-3255 (TrY); Fax: 301-592-8563.