National High Blood Pressure Education Program Complete Report The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute Complete Report The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure This work was supported entirely by the National Heart, Lung, and Blood Institute. The Executive Committee, writing teams, and reviewers served as volunteers without remuneration. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program NIH Publication No. 04-5230 August 2004 Chair has received funding/grant support for research Aram V. Chobanian, M.D. (Boston University projects from Bristol-Myers Squibb, Boehringer- School of Medicine, Boston, MA) Ingelheim, Merck, Pfizer, and Pharmacia; he has served as a consultant/advisor for Abbott, Astra- Executive Committee Zeneca, Biovail, Bristol-Myers Squibb, George L. Bakris, M.D. (Rush University GlaxoSmithKline, Merck, Pfizer, and Pharmacia. Medical Center, Chicago, IL); Henry R. Black, M.D. (Rush University Medical Center, Dr. Carter has served as a consultant/advisor for Chicago, IL); William C. Cushman, M.D. Bristol-Myers Squibb. (Veterans Affairs Medical Center, Memphis, TN); Lee A. Green, M.D., M.P.H. (University Dr. Cushman has received funding/grant support of Michigan, Ann Arbor, MI); Joseph L. Izzo, for research projects from Astra-Zeneca, Merck, Jr., M.D. (State University of New York at Pfizer, Kos, Aventis Pharma, King Buffalo School of Medicine, Buffalo, NY); Pharmaceuticals, GlaxoSmithKline, and Daniel W. Jones, M.D. (University of Mississippi Boehringer-Ingelheim; he has served as a consul- Medical Center, Jackson, MS); Barry J. tant/advisor for Bristol-Myers Squibb, Sanofi, Materson, M.D., M.B.A. (University of Miami, GlaxoSmithKline, Novartis, Pfizer, Solvay, Miami, FL); Suzanne Oparil, M.D. (University Pharmacia, Takeda, Sankyo, Forest, and Biovail. of Alabama at Birmingham, Birmingham, AL); Jackson T. Wright, Jr., M.D., Ph.D. (Case Dr. Izzo has received honoraria for serving as a Western Reserve University, Cleveland, OH) speaker from Boehringer-Ingelheim, Merck, Pfizer, Astra-Zeneca, Solvay, Novartis, Forest, and Executive Secretary Sankyo; he has received funding/grant support for Edward J. Roccella, Ph.D., M.P.H. (National research projects from Boehringer-Ingelheim, Heart, Lung, and Blood Institute, Merck, Astra-Zeneca, Novartis, GlaxoSmithKline, Bethesda, MD) and Biovail; he served as a consultant/advisor for Merck, Astra-Zeneca, Novartis, Intercure, Financial Disclosures Sankyo, and Nexcura; he has stock holdings in Dr. Chobanian has received honoraria for serving Intercure, Nexcura. as a speaker from Monarch, Wyeth, Astra- Zeneca, Solvay, and Bristol-Myers Squibb. Dr. Jones has served as a consultant/advisor for Pfizer, Bristol-Myers Squibb, Merck, Forest, and Dr. Bakris has received honoraria for serving as a Novartis. speaker from Astra-Zeneca, Abbott, Alteon, Biovail, Boerhinger-Ingelheim, Bristol-Myers Dr. Manger has served as a consultant/advisor for Squibb, Forest, GlaxoSmithKline, Merck, the NHBPEP Coordinating Committee. Novartis, Sanofi, Sankyo, and Solvay; he has received funding/grant support for research pro- Dr. Materson has served as a consultant/advisor jects from National Institutes of Health, Astra- for Unimed, Merck, GlaxoSmithKline, Novartis, Zeneca, Abbott, Alteon, Boerhinger-Ingelheim, Reliant, Tanabe, Bristol-Myers Squibb, Pfizer, Forest, GlaxoSmithKline, Merck, Novartis, Pharmacia, Noven, Boehringer-Ingelheim, and Sankyo, and Solvay; he has served as a consul- Solvay. tant/advisor for Astra-Zeneca, Abbott, Alteon, Biovail, Boerhinger-Ingelheim, Bristol-Myers Dr. Oparil has received funding/grant support for Squibb, Forest, GlaxoSmithKline, Merck, research projects from Abbott Laboratories, Novartis, Sanofi, Sankyo, and Solvay. Astra-Zeneca, Aventis, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Forest, Dr. Black has received honoraria for serving as a GlaxoSmithKline, Monarch, Novartis [Ciba], speaker from Astra-Zeneca, Bristol-Myers Squibb, Merck, Pfizer, Sanofi/BioClin, Schering Plough, Novartis, Pfizer, Pharmacia, and Wyeth-Ayerst; he Schwarz Pharma, Scios Inc, GD Searle, Wyeth- The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure iii Ayerst, Sankyo, Solvay, and Texas Biotechnology School, Newark, NJ); Lee A. Green, M.D., Corporation; she has served as a consultant/advi- M.P.H. (University of Michigan, Ann Arbor, sor for Bristol-Myers Squibb, Merck, Pfizer, MI); Stephen Havas, M.D., M.P.H., M.S. Sanofi, Novartis, The Salt Institute, and Wyeth- (University of Maryland School of Medicine, Ayerst; she is also on the Board of Directors for Baltimore, MD); Thomas H. Hostetter, M.D. the Texas Biotechnology Corporation. (National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD); Joseph L. Dr. Sowers has received honoraria for serving as a Izzo, Jr., M.D. (State University of New York speaker from Med Com Vascular Biology at Buffalo School of Medicine, Buffalo, NY); Working Group and Joslin Clinic Foundation; he Daniel W. Jones, M.D. (University of Mississippi has received funding/grant support for research Medical Center, Jackson, MS); Lynn Kirby, projects from Novartis and Astra-Zeneca. R.N., N.P., C.O.H.N. (Sanofi-Synthelabo Research, Malvern, PA); Kathryn M. Kolasa, Dr. Wright has received honoraria for serving as a Ph.D., R.D., L.D.N. (Brody School of Medicine speaker from Astra, Aventis, Bayer, Bristol-Myers at East Carolina University, Greenville, NC); Squibb, Forest, Merck, Norvartis, Pfizer, Phoenix Stuart Linas, M.D. (University of Colorado Pharmaceuticals, GlaxoSmithKline, and Health Sciences Center, Denver, CO); William Solvay/Unimed; he has received funding/grant M. Manger, M.D., Ph.D. (New York University support for research projects from Astra, Aventis, Medical Center, New York, NY); Edwin C. Bayer, Biovail, Bristol-Myers Squibb, Forest, Marshall, O.D., M.S., M.P.H. (Indiana Merck, Norvartis, Pfizer, Phoenix University School of Optometry, Bloomington, Pharmaceuticals, GlaxoSmithKline, and IN); Barry J. Materson, M.D., M.B.A. Solvay/Unimed. (University of Miami, Miami, FL); Jay Merchant, M.H.A. (Centers for Medicare & National High Blood Pressure Education Program Medicaid Services, Washington, DC); Nancy Coordinating Committee Houston Miller, R.N., B.S.N. (Stanford Claude Lenfant, M.D. (National Heart, Lung, University School of Medicine, Palo Alto, CA); and Blood Institute, Bethesda, MD); George L. Marvin Moser, M.D. (Yale University School of Bakris, M.D. (Rush University Medical Center, Medicine, Scarsdale, NY); William A. Nickey, Chicago, IL); Henry R. Black, M.D. (Rush D.O. (Philadelphia College of Osteopathic University Medical Center, Chicago, IL); Medicine, Philadelphia, PA); Suzanne Oparil, Vicki Burt, Sc.M., R.N. (National Center for M.D. (University of Alabama at Birmingham, Health Statistics, Hyattsville, MD); Barry L. Birmingham, AL); Otelio S. Randall, M.D., Carter, Pharm.D., F.C.C.P. (University of Iowa, F.A.C.C. (Howard University Hospital, Iowa City, IA); Francis D. Chesley, Jr., M.D. Washington, DC); James W. Reed, M.D., (Agency for Healthcare Research and Quality, F.A.C.P., F.A.C.E. (Morehouse School of Rockville, MD); Jerome D. Cohen, M.D. (Saint Medicine, Atlanta, GA); Edward J. Roccella, Louis University School of Medicine, St. Louis, Ph.D., M.P.H. (National Heart, Lung, and MO); Pamela J. Colman, D.P.M. (American Blood Institute, Bethesda, MD); Lee Shaughnessy Podiatric Medical Association, Bethesda, MD); (National Stroke Association, Englewood, CO); William C. Cushman, M.D. (Veterans Affairs Sheldon G. Sheps, M.D. (Mayo Clinic, Medical Center, Memphis, TN); Mark J. Rochester, MN); David B. Snyder, R.Ph., D.D.S. Cziraky, Pharm.D., F.A.H.A. (Health Core, Inc., (Health Resources and Services Administration, Newark, DE); John J. Davis, P.A.-C. (American Rockville, MD); James R. Sowers, M.D., Academy of Physician Assistants, Memphis, F.A.C.P., F.A.C.E. (SUNY Health Science Center TN); Keith Copelin Ferdinand, M.D., F.A.C.C. at Brooklyn, Brooklyn, NY); Leonard M. (Heartbeats Life Center, New Orleans, LA); Steiner, M.S., O.D. (Eye Group, Oakhurst, NJ); Ray W. Gifford, Jr., M.D., M.S. (Cleveland Ronald Stout, M.D., M.P.H. (Procter and Clinic Foundation, Fountain Hills, AZ); Gamble, Mason, OH); Rita D. Strickland, Michael Glick, D.M.D. (New Jersey Dental Ed.D., R.N. (New York Institute of Technology, iv The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Springfield Gardens, NY); Carlos Vallbona, Vasilios Papademetriou, M.D., F.A.C.P., M.D. (Baylor College of Medicine, Houston, F.A.C.C. (Veterans Affairs Medical Center, TX); Howard S. Weiss, M.D., M.P.H. Washington, DC); Thomas G. Pickering, M.D., (Georgetown University Medical Center, D.Phil. (Mount Sinai Medical Center, New Washington Hospital Center, Walter Reed Army York, NY); Ileana L. Piña, M.D., F.A.C.C. Medical Center, Washington, DC); Jack P. (University Hospitals of Cleveland, Cleveland, Whisnant, M.D. (Mayo Clinic and Mayo OH); L. Michael Prisant, M.D., F.A.C.C., Medical School, Rochester, MN); Laurie F.A.C.P. (Medical College of Georgia, Augusta, Willshire, M.P.H., R.N. (American Red Cross, GA); Clive Rosendorff, M.D., Ph.D., F.R.C.P. Falls Church, VA); Gerald J. Wilson, M.A., (Veterans Affairs Medical Center, Bronx, NY); M.B.A. (Citizens for Public Action on Blood Virend K. Somers, M.D., Ph.D. (Mayo Clinic Pressure and Cholesterol, Inc., Potomac, MD); and Mayo Foundation, Rochester, MN); Ray Mary Winston, Ed.D., R.D. (American Heart Townsend, M.D. (University of Pennsylvania Association, Dallas, TX); Jackson T. Wright, Jr., School of Medicine, Philadelphia, PA); M.D., Ph.D. (Case Western Reserve University, Humberto Vidaillet, M.D. (Marshfield Clinic, Cleveland, OH) Marshfield, WI); Donald G.