The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: insights and highlights from the chairman
Donald G. Vidt, MD
Alan Bakst, PharmD
Ray W. Gifford, MDAddress reprint requests to R.W.G., Department of Nephrology and Hypertension, A101, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
The fifth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) has recommended a new algorithm for treating hypertension that emphasizes the use of drugs shown in randomized clinical trials to reduce cardiovascular morbidity and mortality—namely, diuretics and beta blockers. The report contains several new sections, including new data from the National Health and Nutrition Examination Survey (NHANES III) on prevalence, awareness, treatment, and control of hypertension, a new classification schema that includes systolic and diastolic criteria, and sections on the effects of cocaine, lithotripsy, cyclosporine, and erythro-poietin to induce or aggravate hypertension. Other topics have been greatly expanded, including special populations and situations, primary prevention of hypertension, and life-style modifications. The JNC V report has also added alpha-1 adrenergic blocking agents and the alpha-beta blocker labetalol to the list of drugs suitable for initial monotherapy in managing hypertension.