"The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure" provides a new guideline
for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of
more than 140 mm Hg is a much more important cardiovascular disease
(CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75
mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive
at 55 years of age have a 90% lifetime risk for developing hypertension; (3)
Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80
to 89 mm Hg should be considered as prehypertensive and require health-promoting
lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should
be used in drug treatment for most patients with uncomplicated hypertension,
either alone or combined with drugs from other classes. Certain high-risk
conditions are compelling indications for the initial use of other antihypertensive
drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor
blockers, β-blockers, calcium channel blockers); (5) Most patients with
hypertension will require 2 or more antihypertensive medications to achieve
goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes
or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal
BP, consideration should be given to initiating therapy with 2 agents, 1 of
which usually should be a thiazide-type diuretic; and (7) The most effective
therapy prescribed by the most careful clinician will control hypertension
only if patients are motivated. Motivation improves when patients have positive
experiences with and trust in the clinician. Empathy builds trust and is a
potent motivator. Finally, in presenting these guidelines, the committee recognizes
that the responsible physician's judgment remains paramount.

https://jamanetwork.com/journals/jama/articlepdf/196589/JSC30096.pdf

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.

Vitamin D Deficiency

The effect of calcemic disorders and uremia on the mineral content of skin.

Phosphate depletion (PD) is associated with multiorgan dysfunction. It has been proposed that this phenomenon is due to two metabolic derangements: (a) there is a reduction in ATP content of cells and hence reduced availability of energy-rich phosphate compounds, and (b) there is a decrease in 2,3-diphosphoglycerate in red blood cells, a change that would increase the affinity of hemoglobin to oxygen resulting in tissue hypoxia. Recent studies have demonstrated that PD is associated with a significant elevation in basal levels of cytosolic calcium [Ca2+]i in many cells. This is due to an increased entry into and decreased extrusion of calcium out of cells. This rise in [Ca2+]i plays a major role in organ dysfunction in PD and in the genesis of decreased ATP content of cells.

Mechanism of organ dysfunction in phosphate depletion: a critical role for a rise in cytosolic calcium.

Chronic renal failure is associated with structural and functional abnormalities of the exocrine system of the pancreas. Certain data suggest that the excess parathyroid hormone (PTH) in these patients may participate in the genesis of these pancreatic derangements. However, direct evidence that PTH exerts a direct effect on the exocrine pancreatic system is not well documented. The present study examined the effects of the intact molecule (1–84 PTH) and of the amino-terminal fragment (1–34 PTH) of the hormone on the basal output of pure pancreatic juice (PPJ) volume and pancreatic protein secretion in the rat. 1–84 PTH but not 1–34 PTH significantly (p

Acute administration of intact parathyroid hormone but not its amino-terminal fragment stimulates volume of pancreatic secretion.

I. Special Presentations.- High Energy Phosphate, Phospholipids and Calcium in Ischemic Renal Tubular Cell Injury.- Calcium, Cell Function and Cell Death.- Primary Hyperparathyroidism (PHP) Revisited.- II. Renal Handling of Phosphate.- Mechanisms of Ion Transport Regulation by Parathyroid Hormone: cAMP/Ca2+/Calmodulin and Phospholipid Dependent Phosphorylation.- Mechanisms of NAD Action in Regulation of Renal Brush Border Membrane Transport of Phosphate.- Interactions between Inorganic Phosphate and Energy Metabolism in Renal Cortical Tubules.- Regulation of Na-Phosphate Cotransport in Cultured Renal Epithelial Cells: Protein-Synthesis-Dependent and Protein-Synthesis-Independent Pathways.- Phosphorin, A Phosphate-Binding Hydrophobic Protein Isolated from Renal Brush Border Membranes.- Intrarenal Phosphate Reabsorption: Role of Nephron Heterogeneity..- Resistance to the Phosphaturic Effects of Parathyroid Hormone during Phosphate Conservation is Due to Enhanced Phosphate Reabsorption by the Pars Recta.- Brush Border Membrane Phosphate Transport Effects of Volume Expansion.- The Direct Effect of 1,25-Dihydroxycholecalciferol on Membrane Phospholipid Composition and Phosphate Transport.- Possible Role of Calcium in Parathyroid Hormone Action on Phosphate Transport in Rabbit Renal Proximal Tubules.- Calcium Stimulates Sodium-Dependent Phosphate Absorption in Rabbit Proximal Convoluted Tubules Perfused In Vitro.- Characteristics of Phosphate Transport Across the Basolateral Membrane of the Proximal Tubule: An In Vivo Study.- Renal Proximal Tubular Brush-Border Membrane Transport of Phosphate with Acute Acidosis.- Effects of Glucagon on Renal and Extrarenal Handling of Pi in Rodents: Evidence for Pi Mobilizing Activity.- III. Renal Handling of Calcium and Magnesium.- Calcium Transport by the Proximal Tubule.- Mechanisms of Calcium Transport in the Thick Ascending Limb of the Loop Henle.- Calcium Transport in the Distal Convoluted Tubule.- Renal Membrane Transport of Calcium.- Renal Tubular Disorders Associated with Hypocalciuria.- Renal Magnesium Wasting Disorders.- Role of PTH, Vitamin D and Bone Metabolism in Low Protein-Induced Hypercalciuria.- IV. Intestinal Absorption of Phosphate and Calcium.- Mechanism and Regulation of Intestinal Phosphate Transport.- Intestinal Absorption of Phosphate in Man: Effect of Drugs.- Mechanism of Phosphate Transport Adaptation in Rat Intestinal and Renal Brush Border Membranes.- Analysis of Calcium Transport in Rat Intestine.- Calcium Absorption in the Rat Colon Measured In Vivo.- Impaired Intestinal Calcium Transport in the Spontaneously Hypertensive Rat.- V. Bone Metabolism.- Cellular Mechanisms of Bone Remodeling Evaluated at the Intermediary Level of Organization of Bone.- The Local Regulation of Bone Remodeling.- Immune Cells and Bone Resorption.- Bisphosphonates Can Reduce Osteoclastic Bone Resorption by Two Different Mechanisms.- Comparison of Aluminum Related with Vitamin D Related Osteomalacia by Tetracycline Based Bone Histomorphometry.- Parathyroid Hormone and 1.25 Vitamin D3 Exert Opposite Effects on Bone.- Serum Bone GLA-Protein Compared to Bone Histomorphometry in Hemodialyzed Patients.- Effects of 1,25(OH)2D3 Administration on Serum Bone GLA Protein in Predialysis Chronic Renal Failure.- Skeletal Mass in Long Term Hemodialysis Patients.- VI. Parathyroid Hormone.- Parathyroid Hormone Antagonists Effective In Vivo.- Solubilization of a Guanine Nucleotide-Sensitive Parathyroid Hormone-Receptor Complex from Canine Renal Cortex.- Parathyroid Hormone Secretory Responses to Peroral Phosphate and Stimulability of Serum Levels of Carboxyl-Terminal Flanking Peptide (PDN-21) of the Human Calcitonin Gene by Calcium in NOrmal and Osteoporotic Patients.- Renal Adenylate Cyclase Stimulating Action of Normal and Oxidized Parathyroid Hormone (1-34).- Hypercalcemia of Malignancy.- Mechanism of the Hypocalcemic Agent WR-2721 and Its Acute and Chronic Application in Eu- and Hyperparathyroidism.- Determinants of Circulating Levels of 1.25(OH)2D3 (Calcitriol) in Primary Hyperparathyroidism (PHPT).- Mechanism of Nephrocalcinosis in Primary Hyperparathyroidism.- Changes in Serum Calcium and Phosphorus Induced by Chronic Renal Failure in the Absence of Parathyroid Hormone.- VII. Minerals and Blood Pressure.- Theoretical Mechanisms of Dietary Calcium's Antihypertensive Action.- Calcium as a Mediator of Salt Sensitive Hypertension.- The Effect of Calcium on Renin, Aldosterone and Prostaglandin Release.- Disturbed Phosphate Metabolism in Spontaneously Hypertensive Rats.- Participation of Various Brain Nuclei in the Altered Time Course of Genetic Hypertension in SHR Dependent on Changes in Calcium Metabolism.- Dissociation Between the Hypotensive Effect of Thiazides and Plasma Divalent Cations.- VIII. NEPHROLITHIASIS.- Urine Citrate and Calcium in Calcium Nephrolithiasis.- Influence of Oxalate on Calcium Oxalate Crystals Formation in Urine Oversaturation.- Therapeutic Modalities for the Prevention of Nephrolithiasis.- IX. Miscellaneous.- Factors Controlling the Intracellular Concentration of Orthophosphate (Pi) in Mammalian Cells.- Phosphate Transfer and 31P Nuclear Magnetic Resonance (NMR) Spectroscopy Pre and Post Hemofiltration (HF).- Regulation of Renal Na-K-ATPase: Effects of Aldosterone in Phosphate Depletion.- Effects of the Impairment of Renal Function and of the pH of Gastric Secretion on the Efficacy of Al(OH)3 to Reduce Serum Inorganic Phosphorus.- Effects of Different Insulin Administration Modalities on Vitamin D Metabolism of Insulin-Dependent Diabetic Patients.- Influence of Inorganic Phosphate on Glucose-Induced Insulin Release In Vitro.- Mechanism of Inhibition of Glycolysis by Vanadate.- Regulation of Na+/H+ Antiport in the Intact Renal Proximal Tubular Cell.- Interaction of Vitamin D-Metabolites with Adenylate Cyclase/Cyclic AMP System: A Biological Model of Controlled Regulation.- Dibutryladenosine 3',5'-Cyclic Monophosphate (dBcAMP) Does Not Mimic the Action of Parathyroid Hormone (PTH) on Canine Proximal Tubular Basolateral Membrane Na+:Ca2+.- Phosphate Transport Through Placenta Brush Border Membrane.

Phosphate and mineral homeostasis

Elevated cytosolic calcium of adipocytes in chronic renal failure

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