This chapter of Clinical Pointers focuses on highlights of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Also know as JNC VI, this document was developed by a group of experts, using consensus and evidence based medicine, to provide guidance to primary care providers in the care of the person with hypertension. Here are some of the document’s key points:

• Nearly 3/4 of adults with HTN continue to have BP readings > 140/90 demonstrating poor HTN control.

• Most non-drug therapies to reduce blood pressure, such as diet and exercise, will also help prevent its development. Guidelines for the DASH (Dietary Approaches to Stop Hypertension) diet are given.

• JNC VI proposes a stratification of risk for those with HTN. In this, the clinician can identify those at greatest risk of HTN related disease or with target organ disease (TOD) and establish treatment priorities in this group. The groups are based on presence or absence of comorbidity and degree of blood pressure elevation.

• The clinical evaluation of the person with HBP should include measurement of height, weight and waist measurement. With visceral or abdominal obesity (waist measurement in women > 34 inches, men > 39 inches), there is a higher rate of dyslipidemia, diabetes and coronary heart disease mortality.

• JNC VI cites compelling indications for the use of select drugs in the treatment of HTN, such as ACE inhibitors with diabetic Proteinuria or in congestive heart failure, the use of diuretics or a long acting dihydropyridine in isolated systolic hypertension, and beta blockers post myocardial infarction.

A detailed analysis of JNC VI is available on tape.