We read with concern the letter JNC VII creates a new “hypertensive” category in MJAFI 2005; 61: 98[1]. The letter dwells on the “fashioning” of a new category termed prehypertension” including individuals with BP 120-139 and /or 80-89 mm Hg by JNC VII [2].
The author has sought to “create” a controversy where none exists. More importantly it sows doubts in the minds of readers especially those not familiar with the complete JNC VII report. This letter deserves a rejoinder as it deals with an important issue affecting a large population. Without going into each and every point raised by the author we would like to make the following observations-
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1
JNC VII is a statement brought out by The National High Blood Pressure Education Program on Prevention, Detection, Evaluation and Treatment of High Blood Pressure which in its VIIth edition has gained widespread acceptance.
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2
JNC VII states that prehypertension is NOT a disease category, rather it defines a group of individuals who have a higher risk of developing hypertension and/or complications thereof and will benefit from follow up and intervention and hence may more appropriately be termed “at risk” category [2].
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3
Non pharmacological therapy is not only an accepted modality of treatment but also the cornerstone of management of all lifestyle diseases like hypertension, diabetes, obesity etc [3]. Thus, lifestyle modifications are more than “meaningful therapies” and should be incorporated in all hypertension management programs and not belittled.
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4
“Cost effectiveness” cannot be a factor in lifestyle modification. Moreover, prevention or retarding the progress of disease is definitely more cost effective than treatment.