[The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the weapons are ready].

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recently came to light in a short version. A complete version will soon be available. JNC 7 is the last attempt to bridge the big gap between the current availability of potent and well tolerated antihypertensive strategies and their poor implementation in the clinical practice. Some new and important features characterize the JNC 7 document. The aim of the new and challenging definition of pre-hypertension (BP 120-139/80-89 mmHg) is to sensitize the general population and health professionals to implement effective strategies for a healthier life in order to prevent hypertension and related cardiovascular disease as early as possible. Stage 3 hypertension has been deleted and merged with stage 2 (systolic > or = 160 or diastolic > or = 100 mmHg). BP levels to achieve with treatment (goals) are < 140/90 mmHg (< 130/80 mmHg in diabetics). To reach the goal, diuretics are recommended for initial treatment in most subjects with stage I hypertension. However, combination of at least 2 drugs is recommended if initial BP is 20/10 mmHg higher than goal BP. Apart from the definition of pre-hypertension and the advice to begin therapy with diuretics in most patients with stage 1 hypertension, JNC 7 shares several positions with the hypertension guidelines recently released by the European Society of Cardiology and European Society of Hypertension. JNC 7 seems to dedicate limited space to stratify the level of cardiovascular risk in the individual subjects on the basis of the different combinations between BP levels and concomitant risk factors. In summary, JNC 7 is an updated and well equipped arsenal of formidable weapons against hypertension and its complications. The stage is now set for an hard task: their effective implementation in the clinical practice with the aim to decrease cardiovascular morbidity and mortality.