Clinician’s Manual:
Treatment of Hypertension

A survey of the literature of the past few decades shows that the definition of
hypertension has changed drastically, and it seems to continue to change. It is
presently recommended that antihypertensive therapy is started in patients
who have “confirmed” hypertension, defined by the Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC 7) as a blood pressure (BP) level exceeding 140/90 mmHg.
However, data from the Framingham Heart Study [1] make it exceedingly clear
that BP is directly related to cardiovascular events, even at levels below that
defined as hypertensive by the JNC 7 [2]. High normal BP was associated with a
several-fold increase of cardiovascular disease in the Framingham population
(Figure 1). A number of recent studies have shown that lowering BP in the socalled normotensive population reduces morbidity and mortality. These recent
data indicate that any arbitrary definition of hypertension, such as BP of above
140/90 mmHg, may not be very useful. It seems time to abandon the dichotomous
partition of the world population into either hypertensive or normotensive