JNC 7 Guidelines and Tools
Evidence-based High Blood Pressure Guidelines and Tools for Local Health Departments (LHDs)
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) provides an evidence-based approach to the prevention and management of hypertension. The leadership of the Management of Risk Factors Committee (Committee Leadership) of the Justus-Warren Heart Disease and Stroke Prevention Task Force reviewed these guidelines in addition to the American Heart Association/American College of Cardiology Foundation 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults in order to determine which guidelines and performance measures could be adopted and implemented within LHDs in North Carolina.
After reviewing these reports, the Committee Leadership determined that 7 guidelines could be best adopted and implemented by LHDs within the structure of a quality improvement (QI) initiative designed to help them improve the quality of the services they provide to their communities. The Committee Leadership then encouraged the N.C. Heart Disease and Stroke Prevention Branch to partner with the NC Center for Public Health Quality to promote these guidelines through the Center’s QI 101 course directed toward training health department staff. As a result, tools were located that correspond to the 7 guidelines identified by the Committee Leadership.
The tools below were created by national organizations, local agencies in other states, and staff of health departments located in North Carolina. These tools are available to all local health department staff who are interested in using evidence-based strategies and best practices to improve their overall processes and services in regards to hypertension management.
JNC 7 Guidelines for Hypertension
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JNC 7 Guideline 1
Create office systems, utilizing Electronic Health Records (EHRs) when available, for tracking patients with uncontrolled blood pressure.
JNC 7 Guideline 2
Improve the technique of taking blood pressure and calibration/maintenance of devices (improve accuracy of readings/diagnosis, and/or use JNC 7 categories of blood pressure severity) by creating a system to monitor and document both human and equipment adherence.
JNC 7 Guideline 3
Create a system that provides medication and lifestyle counseling to patients by identifying appropriate patients through the establishment of an assessment protocol for:
- Medication adherence (tolerance, understanding, and access)
- Check to see if patients who are uncontrolled are on at least 2 medications and develop a process for feedback to care teams on the proportion of patients who are uncontrolled who are on at least 2 medication classes over time
- As a goal, also report on the proportion of patients who are uncontrolled who are on at least 3 medications
- Perform specific tasks to help patients understand their medication regimen (use of teach back technique by team members)
- Lifestyle modifications
- Create a system that incorporates Dietary Approaches to Stop Hypertension (DASH) eating plan
- Create a platform to discuss risk factors with hypertension patients and set diet and physical activity goals with an emphasis on the effect of obesity on hypertension
- Create a system that involves patient input in the development of the care plan to reduce hypertension risk factors and maintain awareness
JNC 7 Guideline 4
Create a project that specifically addresses the control of systolic hypertension to less than 140 mmHg in “older” adults over the age of 50.
No tools are available at this time.
JNC 7 Guideline 5
Create a system for practices to provide patients with goal blood pressure levels and current readings (“know your numbers”) verbally and in writing
JNC 7 Guideline 6
Consider creating a home blood pressure monitoring program, especially for people who are uncontrolled or who have erratic control.
No tools are available at this time.