JNC-IV AND THE EVOLUTION OF STEPPED CARE TO INDIVIDUALIZED TREATMENT OF HYPERTENSION

There have been many changes in the treatment of hypertension over the past few decades. The Joint National Committee on the Detection. Evaluation, and Treatment of High Blood Pressure (JNC) has published four reports since 1977. The first three highlighted diuretic therapy as the main ingredient of stepped care for hypertensive patients. In the fourth report, this position has been revised to a patient-oriented, or individualized, approach. The shift reflects the results of many studies on hypertensive patients treated with a variety of approaches and drugs, including diuretics, β-blockers, angiotensin converting enzyme (ACE) inhibitors, sympatholytics, and calcium channel blockers. After analyzing the patient's history, physical, and laboratory findings, the report recommends making choices from the various agents, based on patient demographics, sequelae, concomitant diseases, and other risk factors such as cholesterol levels. © 1990 Raven Press, Ltd., New York.