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Cross-classification of JNC VI blood pressure stages and risk groups in the Framingham Heart Study
D M Lloyd-Jones1, J C Evans, M G Larson
1National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Mass 01702, USA.
Insights
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) risk stratification shows most high blood pressure patients need drug therapy. Nearly 50 million Americans with hypertension require tailored JNC VI treatment approaches.
Area of Science:
- Cardiology
- Public Health
- Hypertension Management
Background:
- The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) introduced a new risk stratification for hypertension.
- Patients are categorized into risk groups A, B, or C based on cardiovascular disease risk factors, target organ damage, and existing conditions like diabetes.
Purpose of the Study:
- To determine the prevalence of JNC VI blood pressure stages and risk groups in a community-based population.
- To analyze how risk group distribution varies across different blood pressure stages.
Main Methods:
- Analysis of 4962 subjects from the Framingham Heart Study and Framingham Offspring Study (1990-1995).
- Cross-classification of participants by JNC VI blood pressure stages and defined risk groups.
- Separate analysis for men and women.
Main Results:
- Over 43% had optimal/normal blood pressure, while 13.4% had high-normal and 43% had stage 1 or greater hypertension or were on medication.
- As blood pressure stages increased, the proportion of individuals in lower-risk group A decreased, and those in higher-risk group C increased.
- Among individuals with high-normal blood pressure or hypertension, only 2.4% were in risk group A; 59.3% were in group B, and 38.2% were in group C, indicating a significant need for intervention.
Conclusions:
- The findings support the JNC VI risk stratification for guiding hypertension treatment strategies.
- A substantial proportion of individuals with high-normal blood pressure or hypertension fall into risk groups B and C, necessitating interventions beyond lifestyle modification.
- Widespread adoption of JNC VI recommendations could significantly impact clinical practice and public health, given nearly 50 million hypertensive individuals in the US.
Background:
The recently published Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) includes a classification of blood pressure stages and a new risk stratification component. Patients with high-normal blood pressure or hypertension are stratified into risk group A (no associated cardiovascular disease risk factors, no target organ damage or cardiovascular disease); group B (> or =1 associated cardiovascular disease risk factor excluding diabetes, no target organ damage or cardiovascular disease); or group C (diabetes or target organ damage or cardiovascular disease).
Objective:
To examine the prevalence of risk groups and blood pressure stages in a community-based sample.
Methods:
We evaluated 4962 subjects from the Framingham Heart Study and Framingham Offspring Study examined between 1990 and 1995. We cross-classified men and women separately according to their JNC VI blood pressure stages and risk groups.
Results:
In the whole sample, 43.7% had optimal or normal blood pressure and 13.4% had high-normal blood pressure; 12.9% had stage 1 hypertension and 30.0% had stage 2 or greater hypertension or were receiving medication. As blood pressure stage increased, the proportion of subjects in group A decreased, whereas the proportion in group C increased. Among those with high-normal blood pressure or hypertension, only 2.4% (all women) were in risk group A, 59.3% were in group B, and 38.2% were in group C. In the high-normal or hypertensive group, 39.4% qualified for lifestyle modification as the initial intervention according to JNC VI recommendations, whereas 60.6% were eligible for initial drug therapy or were already receiving drug therapy. Nearly one third of high-normal subjects were in risk group C, in which early drug therapy may be needed. Among those in stage 1, only 4.0% were in group A, in which prolonged lifestyle modification is recommended.
Conclusions:
These results provide a foundation for estimating the number of individuals with hypertension who fall into different risk groups that require different treatment approaches. With nearly 50 million individuals with hypertension in the United States, there are important implications for clinicians and policymakers if JNC VI recommendations are widely adopted in clinical practice.