The 6th joint national committee report (JNC-6): new guidelines for hypertension therapy from the USA.

This manuscript will highlight the major elements of the recently published sixth Joint National Committee (JNC-6) report. First, a 3-tiered classification of overall cardiovascular risk is provided as a guide to the institution of therapy with either lifestyle modifications or antihypertensive drugs. Second, the need for prevention is stressed. Third, guidelines for the effective use of appropriate lifestyle modifications are provided. Fourth, a 3-pronged pathway for the choice of critical therapy is provided: one for uncomplicated hypertensive; another for those with "compelling" indications for specific drugs, including the presence of diabetic nephropathy, congestive heart failure, post-myocardial infarction or systolic hypertension in the elderly; the third for those with concomitant conditions that may be either favorably or unfavorably affected by specific types of drugs. In addition, the report emphasizes the need to achieve the goal of less than 140/90 mmHg by a progressive process of therapy and, if necessary, referral to a hypertension specialist. Recommendations are made for improved adherence to therapy, therapy of resistant hypertension and hypertensive crises.