The purpose of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) is to provide guidance for primary care clinicians. The committee recognizes that the responsible clinician’s judgment of the individual patient’s needs remains paramount. Therefore, this national guideline should serve as a tool to be adapted and implemented in local and individual situations. Using evidence-based medicine and consensus, the report updates contemporary approaches to hypertension control. Among the issues covered are the important need for prevention of high blood pressure by improving lifestyles, the cost of health care, the use of self-measurement of blood pressure, the role of managed care in the treatment of high blood pressure, the introduction of new combination antihypertensive medications and angiotensin II receptor blockers, and strategies for improving adherence to treatment. The JNC VI report places more emphasis than earlier reports on absolute risk and benefit and uses risk stratification as part of the treatment strategy. This report strongly encourages lifestyle modification to prevent high blood pressure, as definitive therapy for some, and as adjunctive therapy for all persons with hypertension. On the basis of outcomes data from randomized controlled trials, this report recommends starting pharmacologic therapy with diuretics and beta-blockers for patients with uncomplicated hypertension and provides compelling indications for specific agents in certain clinical situations. This document also states that it is appropriate to choose other classes of antihypertensive agents in certain clinical situations and in patients with comorbid conditions. The National High Blood Pressure Education Program Coordinating Committee will release other advisories as the scientific evidence becomes available.

Contents

• Acknowledgments
• Foreword
• Chapter 1. Introduction
  • Evidence Base
  • Clinical Policy
  • Public Health Challenges of Hypertension
  • Community Programs
  • Summary
• Chapter 2. Blood Pressure Measurement and Clinical Evaluation
  • Detection and Confirmation
  • Self-Measurement of Blood Pressure
  • Ambulatory Blood Pressure Monitoring
  • Evaluation
  • Identifiable Causes of Hypertension
  • Risk Stratification
  • Summary
• Chapter 3. Prevention and Treatment of High Blood Pressure
  • Potential for Primary Prevention of Hypertension
  • Goal
  • Lifestyle Modifications
  • Pharmacologic Treatment
  • Considerations for Adherence to Therapy
  • Hypertensive Crises: Emergencies and Urgencies
  • Summary
• Chapter 4. Special Populations and Situations
  • Hypertension in Racial and Ethnic Minorities
  • Hypertension in Children and Adolescents
  • Hypertension in Women
  • Hypertension in Older Persons
  • Patients with Hypertension and Coexisting Cardiovascular Diseases
  • Patients with Hypertension and Other Coexisting Diseases
  • Patients Undergoing Surgery
  • Miscellaneous Causes for Increased Blood Pressure
  • Summary
• References
• Appendix A - The DASH Diet
• High Blood Pressure Reports and Materials From the National Heart, Lung, and Blood Institute