Fast Breaking Comment by Aram V. Chobanian

Aram V. Chobanian answers a few questions about this month's fast breaking paper in the field of Clinical Medicine.

From •>>February 2004

Field: Clinical Medicine
Article Title: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - The JNC 7 Report
Authors: Chobanian, AV;Bakris, GL;Black, HR;Cushman, WC;Green, LA;Izzo, JL;Jones, DW;Materson, BJ;Oparil, S;Wright, JT;Roccella, EJ
Journal: JAMA-J AM MED ASSN
Volume: 289
Page: 2560-2572
Year: MAY 21 2003
* NHLBI, Natl High Blood Pressure Educ Program, NIH, 31 Ctr Dr, MSC 2480, Bethesda, MD 20892 USA.
* NHLBI, Natl High Blood Pressure Educ Program, NIH, Bethesda, MD 20892 USA.
* Boston Univ, Sch Med, Dept Med, Boston, MA 02118 USA.
* Rush Presbyterian St Lukes Med Ctr, Dept Prevent Med, Chicago, IL 60612 USA.
* Univ Tennessee, Ctr Hlth Sci, Vet Affairs Med Ctr, Dept Prevent Med, Memphis, TN 38163 USA.
* Univ Tennessee, Ctr Hlth Sci, Vet Affairs Med Ctr, Dept Med, Memphis, TN 38163 USA.
* Univ Michigan, Dept Family Med, Ann Arbor, MI 48109 USA.
* SUNY Buffalo, Sch Med, Dept Med & Pharmacol, Buffalo, NY 14260 USA.
* Univ Mississippi, Med Ctr, Dept Med, Jackson, MS 39216 USA.
* Univ Mississippi, Med Ctr, Ctr Excellence Cardiovasc Renal Res, Jackson, MS 39216 USA.
* Univ Miami, Sch Med, Dept Med, Miami, FL USA.
* Univ Alabama, Dept Physiol & Med Biophys, Div Cardiovasc Dis, Birmingham, AL USA.
* Univ Hosp Cleveland, Dept Med, Cleveland, OH 44106 USA.
* Louis Stokes Cleveland Vet Affairs Med Ctr, Dept Med, Cleveland, OH USA.

Why do you think your paper is highly cited?

“Individuals who have normal BP at 55 years of age will have approximately a 90% lifetime risk of developing high BP.”

The paper is highly cited because it provides national guidelines for the management of hypertension. The guidelines have been approved by most major professional healthcare organizations and deal with one of the most important and prevalent chronic diseases in the United States.

Does it describe a new discovery or a new methodology that’s useful to others?

It does not describe a new discovery, although the methods used to develop the consensus guidelines would be useful for others who would attempt to accomplish the same with other diseases.

Could you summarize the significance of your paper in layman’s terms?

The report indicates that cardiovascular disease risk increases progressively beginning at relatively low blood pressure (BP) levels of 115/75 mm Hg; for every increment of BP of 20/10 mm Hg, heart disease and stroke risk will double. Individuals who have normal BP at 55 years of age will have approximately a 90% lifetime risk of developing high BP. Persons who have BP levels between 120-139/80-89 mm Hg should be considered prehypertensive and should adopt a healthy lifestyle to prevent the age-related risk of BP and cardiovascular diseases. To treat uncomplicated high BP, diuretic medications are appropriate for most, either alone or in combination with other useful drugs including beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium antagonists. The majority of patients will require two or more medications to control the hypertension. Only about one-third of individuals who have hypertension are controlled to BP levels less than 140/90 mm Hg. Therefore, it is imperative that health professionals and the public work together to control a disease that is a major cause of death and disability in the US.

How did you become involved in this project?

I was appointed by the Director of the National Heart, Lung, and Blood Institute to chair a committee that was charged to develop the new guidelines.

Aram V. Chobanian
President ad interim, Boston University
University Professor; Professor of Medicine and Pharmacology
John L. Sandson Distinguished Professor of Health Sciences
Boston University School of Medicine
Boston, Massachusetts, USA

ESI Special Topics, February 2004
Citing URL - http://www.esi-topics.com/fbp/2004/february04-AramVChobanian.html