VI Hypertension Treatment Guidelines

Hypertension is an important and modifiable risk factorfor cardiovascular diseases, including myocardial in-farction, stroke, and heart failure, as well as end-stage renal disease (ESRD) and peripheral vascular disease. In 1990, the National Health and Nutrition Examination Surveys (NHANES) estimated that 43 million people, or 24 % of the noninstitutionalized US population over 18 years of age, met the Joint National Committee on Prevention, De-tection, Evaluation, and Treatment of High Blood Pressure (JNC) criteria for the diagnosis of hypertension; only one-half were receiving medication therapy. This makes hyper-tension one of the most prevalent and undertreated dis-eases in the US.1,2 Adequate treatment of hypertension can dramatically reduce the healthcare burden secondary to re-nal, cardiovascular, and other related diseases.1,3 To this end, the JNC and the National High Blood Pressure Edu-cation Program have been working with healthcare profes-sionals and the public to increase awareness, detection, treatment, and control of hypertension. It is the mission of the JNC to evaluate the research and promulgate expert consensus guidelines to assist the healthcare provider in managing patients with hypertension.4,5 Early guidelines advised that the first drug administered should be a thiazide diuretic. Throughout the 1970s and much of the 1980s, this treatment approach remained rela