JNC V revisited: standard of care or individualized treatment for hypertension?

Overview

The fifth report of the National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) has weathered the test of time fairly well. The significant new dimensions of the 1992 document included (1) a new classification system reflecting the recognition that risk from hypertension does not arise at a specific blood pressure level but is continuous, (2) an expanded list of agents suitable for antihypertensive therapy, (3) recognition of the significance of systolic blood pressure as a risk factor, particularly isolated systolic blood pressure in the elderly, (4) identification of diuretics and beta-blockers as agents of first use, and (5) recognition that, in addition to level of blood pressure, absolute risk for cardiovascular disease events should influence the nature of therapy. Concern for matching therapeutic efforts with actual risk of disease and potential for benefit has grown. Some have recommended that drug therapy be reserved for those whose absolute risk of a CVD event is above an arbitrary threshold. The next JNC report is likely to be more precise in linking treatment recommendations to the actual level of risk, as well as level of blood pressure, particularly within the broad range of levels where, in JNC V, the decision to treat was left to individual judgment.