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The fifth Joint National Committee report on the detection, evaluation and treatment of high blood pressure.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Frohlich, Edward David |
| Copyright Year | 1993 |
| Abstract | More than 2(0 years have passed since the National High Blood Pressure Education Program was established and its initial report on the detection, evaluation and treatment of patients with hypertension was released . In those days, on the basis of an arbitrary definition of hypertension as diastolic pressure > i04 mm Hg, 23 million Americans were estimated to have essential hypertension . In addition, in response to the initial results of the Veterans Administration Cooperative Studies, a stepped care algorithm of antihypertensive therapy was proposed . This approach, now considered to be one of therapeutic empiricism, recommended that antihypertensive therapy be initiated with a thiazide diuretic agent (for example, hydrochlorothiazide, 50 mg twice daily) followed, if necessary, by successive therapeutic steps including an adrenergic inhibitor (step 2 : reserpine, for example); a direct-acting smooth muscle relaxing vasodilator (step 3: hydralazine, for example), and a more potent agent (step 4: guanethidine or minoxidil, for example) . Ir. reality, this concept was not at all empiric but founded otn physiologic knowledge . Thus, if therapy was initiated by any of the other agents (in step 2, 3, or 4), the initial pressure reduction would soon be attenuated as a result of intravascular volume expansion (or "pseudotolerance") . Moreover, because the diuretic drug would be effective in approximately 50% or more of patients, its use as an initial therapeutic step was reasonable and doses of possible subsequent medications could be reduced, thereby diminishing chances of associated side effects . This concept soon caught hold and, over the ensuing years, a dramatic reduction in deaths from stroke, coronary heartn disease and overall cardiovascular diseases resulted . With the report of the Hypertension Detection and Follow-Up Program, definition of hypertension was modified to include all patients whose diastolic pressure exceeded 89 mm Hg, thereby increasing the number of patients with hypertension to upward of 59 million Americans . In the subsequent reports of the Joint National Committee (JNC) on Detection, Evaluation, and Treatment of High Blood Pressure, the beta-adrenergic receptor blocking agent was suggested as an |
| Starting Page | 665 |
| Ending Page | 668 |
| Page Count | 4 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://core.ac.uk/download/pdf/82589533.pdf |
| PubMed reference number | 8335838v1 |
| Volume Number | 22 |
| Issue Number | 2 |
| Journal | Journal of the American College of Cardiology |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Adrenergic Receptor Antihypertensive Agents Cardiovascular Diseases Cerebrovascular accident Cessation of life Diastole Diastolic blood pressure Dietary Mercury Eighty Nine Fifty Nine Guanethidine Hydralazine Hydrochlorothiazide Hypertensive disease Minoxidil Patients Pulmonary Hypertension Reserpine Smooth muscle (tissue) Temporomandibular Joint Disorders Thiazide Diuretics Thiazides Vasodilator Agents beta-2 Adrenergic Receptors |
| Content Type | Text |
| Resource Type | Report |
