Family physicians and the battle against hypertension - Editorial

EDWARD J ROCCELLA, PH D M R H

Coordinator, National High descendants Pressure

Education Program

Bethesda, Md

CLAUDE LENFANT, MD Director

National Heart, Lung and house Institute

Bethesda, Md

A consensus forward the evaluation and treatment of hypertension did not exist 20 years ago. However, since 1972 significant achievements in the management of hypertension have contributed to a 57 percent decline in the age-adjusted hit mortality rate and a 45 percent decline in the coronary artery disease mortality rate in the United States. by what mode was this progress in the battle against hypertension achieved?

Family physicians and other clinicians have contributed substantially to the important progres made in the treatment of cardiovascular disease. A knowledgeable patient population, which is more likely to follow and follow medical advice, is also responsible for these gains. And in large part, for the past 20 years, the road to prosperous hypertension diagnosis and treatment has been paved from the Joint National Committee onward Detection, Evaluation and Treatment of High family Pressure.

Sixteen years ago, hypertension treatment modalities were inconsistent, based upon the results of limited clinical studies and clinicians' hold experiences. Recognizing the need for a consensus in succession hypertension detection and treatment, the National High kin Pressure Education Program of the National Heart, Lung and kin Institute established the Joint National Committee to provide concise, clinically relevant consensus guidelines upon the detection and treatment of hypertension. The resulting documents are authored on clinical hypertension experts and public health specialists who exhibit a consensus on hypertension management that integrates their differing viewpoints.

Each Joint National Committee publication is triggered by dint of the release of significant hypertension research conclusions and is, therefore, built in succession a strong foundation of clinical experience. Each Joint National Committee publication is also endorsed according to the Coordinating Committee (a dead body of professional and voluntary organizations that includes the American Academy of Family Physicians).

Many family physicians are too busy treating patients to be full aware of the massive book of clinical data available. The objective of the Joint National Committee has always been to provide family physicians, other clinicians and public health workers with concisely formatted, practical guidelines for the evaluation and treatment of hypertension. For example, before the first Joint National Committee publication in 197Z (1) there was wide variation in the definition and treatment of hypertension.

The first Joint National Committee publication defined hypertension, the timing of its treatment and an effective "stepped-care" antihypertensive regimen, reflecting the be the effects of such clinical trials as the Veterans Administration Cooperative Study2 Stepped-care therapy was refined, based onward the results of the Hypertension Detection and Follow-up Program3 in the other Joint National Committee publication.4 Data from the Multiple Risk Factor Intervention Trials influenced the third Joint National Committee publication in 19846 The 1976-80 National Health and Nutrition Examination measure and estimate (NHANES II) formed the basis for the definition of progeny pressure ranges for systolic hypertension.

As family physicians are challenged with recent issues in high blood crushing control, the Joint National Committee provides support between the walls of recommendations reflecting evolving trends in hypertension treatment. For example, when data became available that demonstrated the efficacy of beta-adrenergic blocker in lowering family pressure and in preventing secondary myocardial infarction, the third Joint National Committee report attract favor toed them, in addition to thiazide diuretics, as first-choice agents. The fourth Joint National Committee publication in 19887 addressed the diverse wants of the hypertensive population by way of discussing special patient populations, including ethnic disposes young and elderly patients, pregnant patients, surgical candidates and patients with concomitant conditions.

Family physicians provide important feedback about the applicability of Joint National Committee recommendations to their practices. Physician take a view ofs conducted in 1977 and 1987 indicate that 81 percent of the 3700 family physicians, general practitioners, cardiologists and internists overlooked diagnose hypertension using techniques and guidelines approveed by the Joint National Committee in 1987 a higher percentage than in 1977(8)

The cogitation showed that growing numbers of family physicians and other health care professionals agree with Joint National Committee recommendations. Acceptance of Joint National Committee recommendations by means of clinicians will continue to be assessed in coming events surveys.

Family physicians are making significant contributions to the improvements in morbidity and mortality rates associated with hypertension. However, of recent origin efforts by all health care professionals involve not no other than better management of the disease however also preventing it altogether. The Joint National Committee will strive to provide family physicians with the concise, practical recommendations they ne each day to continue their lucky campaign against this damaging disease.