Glick 585-586.qxd

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 pressure guidelines
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in JNC VI have been replaced by a “pre- exceeds 115/75 millimeters of mercury.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 Indapamide
concerns. The use of epinephrine in local anes-thetic solutions is not contraindicated, as this will Metolazone
result in only a minimal adverse cardiovascular response. However, when general anesthetic is Polythiazide
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 “glickmi@umdnj.edu”. 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[9362]: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.

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