D E N T I S T R Y A B S T R A C T Background. In December 2003, the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute finalized the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, called JNC 7. Overview and Conclusions. On the basis of new trials and observational COVER STORY
studies, and the need for clear and conciseguidelines, the JNC implemented changesin blood pressure classification, nomencla-
The new blood
ture, treatment and prevention in the JNC7 report. One of the key messages of thereport is that systolic blood pressure higher
than 140 millimeters of mercury in peopleolder than 50 years of age is a more impor-
tant risk factor than diastolic blood pres-sure. Another finding is that people with
MICHAEL GLICK, D.M.D.
normal blood pressure at the age of 55 to 65 years have an 80 to 90 percent risk of devel- oping hypertension by the age of 80 to 85 years. Clinical Implications. JNC 7 empha- sizes that health care professionals besides physicians, including dentists, need to help In December 2003, the National High Blood Pres-
sure Education Program finalized the SeventhReport of the Joint National Committee on Preven-tion, Detection, Evaluation, and Treatment of High
Blood Pressure, or JNC 7.1 This report is the latest
related lifestyle modifications, pharmaco-
in a series of reports initiated in 1972 that outline the
standards of care and prevention for patients with high
blood pressure and hypertension. When enough new
information with clinical ramificationshas accumulated, new guidelines are
Dentists need to generated.
risk factor than diastolic pressure. help patients hypertension by based on a couple of seminal studies reinforcing regarding new directions for care and lifestyle new data on hypertension and risk for modifications, developing cardiovascular disease.2,3 The pharmacological resulting new guidelines contain four therapies and adherence to disease and stroke increases progres-
The “normal” and “borderline” stages
treatment. sively and linearly when blood pressure
in JNC VI have been replaced by a “pre-
exceeds 115/75 millimeters of mercury.
dThe risk of developing cardiovascular disease doubles
for every increment of 20 mm Hg of systolic blood pres-
sure or 10 mm Hg of diastolic blood pressure.
dSystolic blood pressure higher than 140 mm Hg in
people older than 50 years of age is a more important
Copyright 2004 American Dental Association. All rights reserved. D E N T I S T R Y
Monitoring blood pressure is an integral part of
THIAZIDE DIURETICS USED TO
hypertension control. JNC 7 emphasizes that
TREAT HIGH BLOOD PRESSURE.
health care professionals besides physicians,including dentists, need to help patients by rein-
GENERIC NAME USUAL DOSAGE (MG*/DAY)
forcing lifestyle modifications, pharmacologicaltherapies and adherence to treatment. Chlorothiazide Chlorthalidone DENTAL ISSUES Hydrochlorothiazide,
The recommendation in JNC 7 for treatment of
dental patients with hypertension addresses two
concerns. The use of epinephrine in local anes-thetic solutions is not contraindicated, as this will
result in only a minimal adverse cardiovascular
response. However, when general anesthetic is
used with patients taking antihypertensive medi-
cations, there is a potential for wide fluctuationsin blood pressure and a risk of hypotension.
“Stage 3” in JNC VI have been replaced by one
The changes in JNC 7 do not alter previously
stage (“Stage 2”) in JNC 7. Management of the
published dental protocols for treatment of
medical care of patients with blood pressure of
patients with hypertension,4 which were based on
160/100 mm Hg or higher versus patients with
blood pressure of 180/110 mm Hg or higher will
Dr. Glick is professor and chairman, Department of Diagnostic Sci-
not change significantly. Thus, two levels are not
ences, New Jersey Dental School, University of Medicine and Dentistry
of New Jersey, 110 Bergen Street, Room D860, Newark, N.J. 07103-2400, e-mail “email@example.com”. Address reprint requests to Dr. Glick. CHANGES IN TREATMENT AND PREVENTION
1. Chobanian AV, Bakris GL, Black HR, et al.; National Heart, Lung,
and Blood Institute Joint National Committee on Prevention, Detec-
The primary goal of hypertensive therapy is to
tion, Evaluation, and Treatment of High Blood Pressure. NationalHeart, Lung, and Blood Institute; National High Blood Pressure Edu-
control blood pressure at a level of less than
cation Program Coordinating Committee. Seventh report of the Joint
140/90 mm Hg. For patients with diabetes or
National Committee on Prevention, Detection, Evaluation, and Treat-ment of High Blood Pressure. Hypertension 2003;42:1206-52.
renal disease, this level is even lower: less than
2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific
130/80 mm Hg. The majority of patients will
relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective
require two or more antihypertensive medica-
studies (Published correction appears in Lancet 2003;361:1060).
tions to achieve these control rates. The pre-
3. The ALLHAT Officers and Coordinators for the ALLHAT Collabo-
ferred initial medication is a thiazide-type
rative Research Group. Major outcomes in high-risk hypertensive
patients randomized to angiotensin-converting enzyme inhibitor or cal-cium channel blocker vs diuretic: the Antihypertensive and Lipid-
Lifestyle modifications—such as weight loss;
Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (pub-
reduced sodium intake; adoption of the Dietary
lished correction appears in JAMA 2003;289:178). JAMA2002;288:2981-97.
Approaches to Stop Hypertension, or DASH, diet;
4. Glick M. New guidelines for prevention, detection, evaluation and
regular aerobic physical activity; and limited
treatment of high blood pressure. JADA 1998;129:1588-94.
alcohol intake—are beneficial for both prevention
Copyright 2004 American Dental Association. All rights reserved.
02_Inhalt_183-302 31.01.2005 7:18 Uhr Seite 237Rempfler · FIFA-Reglement als anationales materielles Recht? FIFA-Reglement als anationales materielles Recht? Lic. iur. Christa Rempfler, St. Gallen Das Handelsgericht des Kantons St. Gallen hat die KlageStreitigkeit dem «Schiedskomitee» der FIFA zu unter-einer in der Schweiz domizilierten Spielervermittlungs-agentur (deren Inhaber die vo
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT 2. QUALITATIVE AND QUANTITATIVE COMPOSITION • Active substance: Each enteric coated tablet contains 45.10 mg of pantoprazole sodium sesquihydrate equivalent to 40 mg of pantoprazole. For a full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM A yellow, oval biconvex enteric coated tablet