JNC-7 Guidelines Research Articles

Fixed combination therapy of hypertension: focus on valsartan/hydrochlorothiazide combination (Diovan®/HCT)

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Monotherapy of hypertension is often ineffective, since it controls approximately 50% of the blood pressure of hypertensive patients. For lowering blood pressure to less than 140/90 mmHg (or <130/80 mmHg among people with diabetes or chronic renal disease) according to JNC-7 guidelines, combination therapy of two or more drugs is often necessary. The combination of a diuretic with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) is effective and provides the additional benefit of blocking the effects of angiotensin II, which is responsible for cardiovascular remodeling and its complications. ARBs may have an advantage over the ACEIs because they block the action of all angiotensin II directly, whereas ACEIs are ineffective in blocking angiotensin II generated by nonclassical ACE pathways. Valsartan (Diovan®, Novartis) is one of the seven currently approved ARBs in the USA for the treatment of hypertension, and it has been shown to be very effective in controlling blood pressure given once-daily in doses of 80–160 or 320 mg. Its fixed combination with hydrochlorothiazide (HCT) is even more effective in controlling blood pressure in 70% of the cases. The most commonly used combinations are valsartan/HCT (Diovan/HCT), 80/12.5 and 160/12.5 mg given once-daily.

Prevalence and determinants of hypertension among students of the University of Kinshasa, Democratic Republic of Congo: a cross-sectional study.

The 2017 ACC/AHA Guideline categorized blood pressure into 4 levels:normal (SBP<120 and DBP <80mm Hg), elevated (SBP of 120-129 or DBP< 80 mmHg) and stage 1 (SBP of 130-139 or DBP of 80-89 mm Hg) or 2 (SBP≥140 orDBP≥90mmHg). Compared with the JNC7 guideline, the 2017 ACC/AHA guideline recommends using lower SBP and DBP levels to define hypertension. To determine the prevalence of hypertension as well as associated factors among students of the University of Kinshasa. This was a cross-sectional study conducted at the University of Kinshasa and including 1 281 students aged between 18 and 30. Blood pressure was assessed according to the WHO STEPwise approach, which is a standardized method of data collection, analysis and dissemination for the surveillance of non-communicable diseases in WHO member countries. The Chi-square and Student's t-tests and a multivariate logistic regression analysis have been used to evaluate the results. Statistical analyses were done using IBM SPSS version 21. The prevalence of hypertension according to the guidelines from the 2017 ACC/AHA and the JNC 7 was 26.4 % (CI 95%; 23.9 - 28.9) and 7.3 % (CI 95%; 5.8 - 8.8), respectively. The results of multivariate logistic regression analysis showed that smoking, alcohol abuse, overweight, male sex, age ≥ 24 years old and low physical activity were associated with hypertension (p < 0.0001). At least one out of four students had hypertension. These data should encourage public health authorities to develop strategies for screening of BP and topromote the adoption of healthy lifestyle in young adults.