Hypertension management in 2002: where have we been? where might we be going?

The term "blood pressure" was coined almost 300 years ago by the man who first measured it, the Reverend Stephen Hales of England. However, our understanding of the pathogenesis and consequences of hypertension, as well as the available treatments for it, have remained greatly limited and inadequate until only the past 30 years. Starting in 1977, reports from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC) have provided regular updates on developments in hypertension management, and have set guidelines for the diagnosis and treatment of hypertension. More than 20 years ago, the JNC stratified blood pressure (BP) levels into categories of mild, moderate, and severe (later renamed stages 1, 2, and 3, respectively). A stepped-care approach to hypertension therapy was originally recommended. With each revised JNC report, there was a reduction in target BP and a growing recognition of the importance of high-normal BP and isolated systolic hypertension. The sixth and most current report of the Joint National Committee, JNC VI, emphasizes treatment of comorbidities of hypertension, sets a lower BP goal (<130/85 mm Hg) for high-risk patients-eg, those with diabetes or renal disease-than for those with uncomplicated hypertension (<140/90 mm Hg), and places a greater emphasis on disease prevention. For the future, the current trend toward lower BP goals suggests that more effective and better tolerated antihypertensive therapies will be needed. Multiple antihypertensive agents used concomitantly will likely be needed to control elevated levels of BP in the majority of hypertensive patients.