Make the Diagnosis

The JNC 7 Blood Pressure Classification System

Classification of Blood Pressure for Adults (>18 years of age)
Blood Pressure Classification Systolic Blood Pressure
(mm Hg)
Diastolic Blood Pressure
(mm Hg)
Normal <120 and <80
Prehypertension (Normal) 120–139 or 80–89
Stage 1 Hypertension 140–159 or 90–99
Stage 2 Hypertension >160 or >100

FYI | Why use the JNC 7 Classification System?

“Because of the data on lifetime risk of hypertension and the impressive increase in the risk of cardiovascular complications associated with levels of BP previously considered to be normal, the JNC 7 report has introduced a new classification that includes the term “prehypertension” for those with BPs ranging from 120–139 mmHg systolic and/or 80–89 mmHg diastolic. This designation is intended to identify those individuals in whom early intervention by adoption of healthy lifestyles could reduce BP, decrease the rate of progression of BP to hypertensive levels with age, or prevent hypertension entirely.” (JNC 7 Report, 2003) The JNC 8 did not address diagnosis and classification of hypertension.

Classifying your patient’s hypertension

Question 3:

You have brought back your patient, Mary Johnson, for a second appointment to evaluate her blood pressure. From her first visit, she had a blood pressure of 145/80 in both arms taken 2 minutes apart. The rest of her physical exam was negative. Today, you repeat the blood pressures and get 148/ 79 in the left arm and 148/80 in the right arm. How do you diagnose and classify Mary Johnson’s blood pressures? (Choose the  best answer)

  1. Mary Johnson is not hypertensive.
  2. Mary Johnson is prehypertensive.
  3. Mary Johnson is diagnosed with Stage 1 Hypertension.
  4. Mary Johnson is diagnosed with Stage 2 Hypertension.
  5. Mary Johnson cannot be diagnosed at this second visit.

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Question 4:

What is prehypertension? (Choose the best answer)

  1. The diagnosis of prehypertension is confirmed when an average of two or more blood pressure measurements on separate visits reveal a DBP of 80-89 mm Hg or SBP of 120-139 mm Hg.
  2. Patients with prehypertension are at increased risk of adverse outcomes compared to normotensive patients.
  3. Patients with prehypertension are at high risk of progression to hypertension.
  4. Patients with diabetes or renal disease and prehypertension should be treated as hypertensive if their SBP is =130 mm Hg, or their DBP is =80 mm Hg.
  5. All of the above statements are true.

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