1. Management of Hypertension according to JNC 7
BY SANDAR KYI, MD

2. Introduction
Hypertension is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge.
In the US: Forty-three million people are estimated to have hypertension

3. Introduction
Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population

4. Introduction
Generally, the higher the blood pressure, the greater the risk. Untreated hypertension affects all organ systems and can shorten one's life expectancy by 10 to 20 years.

5. Introduction
The question is, what are the barriers to the management of hypertension according to JNC 7?.

6. Hypothesis
It is a hypothesis that barriers to the effective management of patient with uncontrolled hypertension include
patient management time constraints,
physician practice patterns,
drug adverse effects, and
patient specific factors such as lack of adherence to therapy, limited access to care, financial barriers related to the cost of medications & lack of knowledge about the seriousness of uncontrolled hypertension.

7. Methods
Random chart reviews of 200 patients out of 500 charts those are following in FCC of RCRMC for hypertension from
Sex – F:M 157:43
Race – Hispanic : Non-Hispanic
: 85
Smoker : Non Smoker - 58:142
Inclusion Criteria : pt with pre-hypertension, HTN stage 1,stage 2 according to JNC 7.

8. Methods All charts were reviewed following factors:
- Demographic factor: age, sex, culture background, first language
-co-morbidity: hypercholesterolemia, IHD, diabetes
outcome of BP treatment:
acute coronary event (CP, angina, MI,CHF, bypass surgery)
stroke (TIA, CVA both ischemic and hemorrhagic)
BP whether reached goal BP or not

9. JNC VII report recommendations
Initial therapy based on the JNC VII report recommendations is as follows:
Prehypertension (systolic , diastolic 80-89): No antihypertensive drug is indicated. (f/up BP measure within 1 yr).
Stage 1 hypertension (systolic , diastolic 90-99): Thiazide-type diuretics are recommended for most. ACE inhibitor, angiotensin II receptor blocker (ARB), beta-blocker, calcium channel blocker, or combination may be considered.
Stage 2 hypertension (systolic more than 160, diastolic more than 100): Two-drug combination (usually thiazide-type diuretic and ACE inhibitor or ARB or beta-blocker or calcium channel blocker) is recommended for most.
For the compelling indications, other antihypertensive drugs (eg, diuretics, ACE inhibitor, ARB, beta-blocker, calcium channel blocker) may be considered as needed.

10. JNC 7 Reference Card

11. JNC 7 Reference Card

12. Number of patients with HTN who f/up in FCC

13. Number of patients with HTN who did not reach goal BP

14. Complication in non-compliant patients

15. Complication in patient whose Dr not following JNC 7

16. Complication in patients who did not take med: due to SE

17. Complication in patients who reached goal BP

18. % of Acute Coronary Event Complication

19. Numbers of patients with co-morbidity
In pts who reached goal BP (25%)
In pts who were non-compliant – 34 (52%)
In pts who didn’t take med: due to SE – 10 (32%)
In pts whose Dr not following JNC (47%)

20. Numbers of patients with co-morbidity

21. Discussion
Thus, according to this study, patient non-compliant had been identified as one of the main reasons that BP therapy fails.
Drug adverse effects have also been identified as a factor related to physician prescribing pattern of hypertensive medications.

22. Discussion
Other findings seem to suggest that physicians are familiar with the JNC 7 guidelines for treating HTN but do not implement this knowledge into their everyday practice.
BP is one of the contributing factor to get complication but other co-morbidities (high cholesterol, DM ) can also contribute to complications.

23. Conclusion
This study clearly demonstrates that positive association between uncontrolled HTN & complication (such as cardiovascular disease , CVA,).
The finding of this study provide useful information for designing effective physician interventions for the management of patients with uncontrolled HTN.

24. Limitations of Research Study
Small sample sizes with 6yrs duration.
Didn’t review patient cultural background, educational status, BMI, smoking history details, control of diabetic, & control of hypercholesterolemia.
Also not mentioned Duration of Physician time spent with pt. Usage of language interpreter if pt doesn’t speak English as first language.

25. Recommendation Further extensive study to include following factors:
patient cultural background, educational status, BMI, smoking history details, control of diabetic & control of hypercholesterolemia.
Duration of Physician time spent with pt. Usage of language interpreter if pt doesn’t speak English as first language.

26. References
Barriers to Blood Pressure Control G. Divakara Murthy Archives of Internal Medicine
E-medicine HTNSat Sharma, MD, FRCPC, FACP, FCCP, DABSM, Program Director, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Manitoba; Site Director of Respiratory Medicine, St Boniface General Hospital
The National High Blood Pressure Education Program

27. Thank you!