JOINT NATIONAL COMMITTEE (JNC) GUIDELINES FOR HYPERTENSION
| A | No need to treat | |
| B |
Diet modification and exercise |
|
| C |
Diet modification, exercise & drugs |
|
| D |
Drugs alone |
Management of uncomplicated essential hypertension is:
| A |
No need to treat |
|
| B |
Diet modification and exercise |
|
| C |
Diet modification, exercise & drugs |
|
| D |
Drugs alone |
Answer is C (Diet modification, exercise & drugs)
Management of uncomplicated essential hypertension includes health promoting lifestyle modifications (includes dietry modification & exercise) and pharmacological therapy (drugs).
Management of Uncomplicated Essential Hypertension
Lifestyle modification
|
Weight reduction |
Attain and maintain BMI <25 kg/m2 |
|
Dietary salt reduction |
<6 g NaCl/d |
|
Adapt DASH- |
Diet rich in fruits, vegetables, and low-fat |
|
type dietary plan |
dairy products with reduced content of saturated and total fat |
|
Moderation of |
For those who drink alcohol, consume 2 |
|
alcohol |
drinks/day in men and I drink/day in |
|
consumption |
women |
|
Physical activity |
Regular aerobic activity, e.g., brisk walking for 30 min/d |
- In uncomplicated essential hypertension the treatment is started with a low-dose thiazide (hydrochlorothiazide 12.5-25 mg per day), an ACE inhibitor or a beta-blocker.
- Calcium-channel blocker can be used as the first-line treatment if the systolic pressure is high.
- Angiotensin-II receptor antagonists should be considered when the adverse effects of ACE inhibitors or other drugs have proven problematic.
- If no response is achieved, or adverse effects emerge, a
product of another drug group should be prescribed. - Combination therapy is started if desired blood pressure reduction is not achieved with monotherapy.
- The reasons behind poor response must be established.
| A | A or D | |
| B |
A or B |
|
| C |
A or C |
|
| D |
C or D |
Ans. is ‘d’ i.e., C or D
Pharmacological treatment of hypertension
Indications of drug therapy (the British hypertension society guidelines).
When sustained BP exceeds 160/100 mmHg or.
When BP is in the range of 140-159 / 90-99 mmHg and there is target organ damage or cardiovascular disease.
For diabetics when BP exceeds 140/90 mmHg.
The optimal target is to lower BP to or below 140/85 mmHg in nondiabetics and 140/80 mmHg in diabetics (WHO target is 130/85 mmHg).
Drug therapy
A simple stepped AB/CD regimen is used.
