This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (170)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Hypertension  • Alert me on articles by topic

Clinical and Public Health Advisory From the National High Blood Pressure Education Program

Paul K. Whelton, MD, MSc; Jiang He, MD, PhD; Lawrence J. Appel, MD, MPH; Jeffrey A. Cutler, MD, MPH; Stephen Havas, MD, MPH, MS; Theodore A. Kotchen, MD; Edward J. Roccella, PhD, MPH; Ron Stout, MD, MPH; Carlos Vallbona, MD; Mary C. Winston, EdD, RD; Joanne Karimbakas, MS, RD; for the National High Blood Pressure Education Program Coordinating Committee

JAMA. 2002;288:1882-1888.

The National High Blood Pressure Education Program Coordinating Committee published its first statement on the primary prevention of hypertension in 1993. This article updates the 1993 report, using new and further evidence from the scientific literature. Current recommendations for primary prevention of hypertension involve a population-based approach and an intensive targeted strategy focused on individuals at high risk for hypertension. These 2 strategies are complementary and emphasize 6 approaches with proven efficacy for prevention of hypertension: engage in moderate physical activity; maintain normal body weight; limit alcohol consumption; reduce sodium intake; maintain adequate intake of potassium; and consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat. Applying these approaches to the general population as a component of public health and clinical practice can help prevent blood pressure from increasing and can help decrease elevated blood pressure levels for those with high normal blood pressure or hypertension.

Author Affiliations: Department of Epidemiology and Medicine, Tulane University Health Sciences Center (Dr Whelton) and Department of Epidemiology, School of Public Health and Tropical Medicine (Dr He), Tulane University, New Orleans, La; Departments of Internal Medicine, Epidemiology, and International Health, Johns Hopkins Medical Institutions, Baltimore, Md (Dr Appel); Division of Epidemiology and Clinical Applications (Dr Cutler) and National High Blood Pressure Education Program, Office of Prevention, Education, and Control (Dr Roccella), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore (Dr Havas); Department of Medicine, Division of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee (Dr Kotchen); Health Care Research Center, The Procter and Gamble Company, Mason, Ohio (Dr Stout); Department of Family and Community Medicine, Baylor College of Medicine, Houston, Tex (Dr Vallbona); American Heart Association, Dallas, Tex (Dr Winston); and American Institutes for Research Health Program, Silver Spring, Md (Ms Karimbakas).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence
Bassuk and Manson
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:191-213.
ABSTRACT  

Hypertension: Pathways to Success
Jones and Hall
Hypertension 2008;51:1249-1251.
FULL TEXT  

Alcohol Consumption and the Risk of Hypertension in Women and Men
Sesso et al.
Hypertension 2008;51:1080-1087.
ABSTRACT | FULL TEXT  

Blood Pressure Change and Risk of Hypertension Associated With Parental Hypertension: The Johns Hopkins Precursors Study
Wang et al.
Arch Intern Med 2008;168:643-648.
ABSTRACT | FULL TEXT  

Nonaspirin Nonsteroidal Anti-inflammatory Drugs and Hemorrhagic Stroke Risk: The Acute Brain Bleeding Analysis Study
Choi et al.
Stroke 2008;39:845-849.
ABSTRACT | FULL TEXT  

Dietary Phosphorus and Blood Pressure: International Study of Macro- and Micro-Nutrients and Blood Pressure
Elliott et al.
Hypertension 2008;51:669-675.
ABSTRACT | FULL TEXT  

Physical fitness, BMI and sickness absence in male military personnel
Kyrolainen et al.
Occup Med (Lond) 2008;0:kqn010v1-kqn010.
ABSTRACT | FULL TEXT  

State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health
O'Neil and Nicklas
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:457-481.
ABSTRACT  

A Prospective Study of Cigarette Smoking and Risk of Incident Hypertension in Women
Bowman et al.
J Am Coll Cardiol 2007;50:2085-2092.
ABSTRACT | FULL TEXT  

Quercetin Reduces Blood Pressure in Hypertensive Subjects
Edwards et al.
J. Nutr. 2007;137:2405-2411.
ABSTRACT | FULL TEXT  

Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome
Lien et al.
Hypertension 2007;50:609-616.
ABSTRACT | FULL TEXT  

The Urgent Need to Reduce Sodium Consumption
Havas et al.
JAMA 2007;298:1439-1441.
FULL TEXT  

Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake: A Report of the Council on Science and Public Health
Dickinson et al.
Arch Intern Med 2007;167:1460-1468.
ABSTRACT | FULL TEXT  

Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide: A Randomized Controlled Trial
Taubert et al.
JAMA 2007;298:49-60.
ABSTRACT | FULL TEXT  

Sodium and Potassium in the Pathogenesis of Hypertension
Adrogue and Madias
NEJM 2007;356:1966-1978.
FULL TEXT  

Treatment of Hypertension Critical in Reducing Morbidity and Mortality
Wexler
J Am Board Fam Med 2007;20:322-322.
FULL TEXT  

High-Resolution Mapping for Essential Hypertension Using Microsatellite Markers
Yatsu et al.
Hypertension 2007;49:446-452.
ABSTRACT | FULL TEXT  

Comparison of Interleukin-6 and C-Reactive Protein for the Risk of Developing Hypertension in Women
Sesso et al.
Hypertension 2007;49:304-310.
ABSTRACT | FULL TEXT  

African american culture and hypertension prevention.
Peters et al.
West J Nurs Res 2006;28:831-854.
ABSTRACT  

A Primer on the Design, Conduct, and Interpretation of Clinical Trials
Appel
CJASN 2006;1:1360-1367.
ABSTRACT | FULL TEXT  

Effects of Job Strain on Blood Pressure: A Prospective Study of Male and Female White-Collar Workers
Guimont et al.
Am. J. Public Health 2006;96:1436-1443.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Circulation 2006;113:e873-e923.
ABSTRACT | FULL TEXT  

Managing hypertension in patients with type 2 diabetes mellitus.
Dobesh
Am J Health Syst Pharm 2006;63:1140-1149.
ABSTRACT | FULL TEXT  

Resistance Exercise Training: Its Role in the Prevention of Cardiovascular Disease
Braith and Stewart
Circulation 2006;113:2642-2650.
FULL TEXT  

ASHP Therapeutic Position Statement on the Treatment of Hypertension.
Zillich and Haines
Am J Health Syst Pharm 2006;63:1074-1080.
FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Stroke 2006;37:1583-1633.
ABSTRACT | FULL TEXT  

Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker
Julius et al.
NEJM 2006;354:1685-1697.
ABSTRACT | FULL TEXT  

Randomized controlled trial on lifestyle modification in hypertensive patients.
Cakir and Pinar
West J Nurs Res 2006;28:190-209.
ABSTRACT  

Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals
Okonofua et al.
Hypertension 2006;47:345-351.
ABSTRACT | FULL TEXT  

Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association
Appel et al.
Hypertension 2006;47:296-308.
ABSTRACT | FULL TEXT  

Cardiorespiratory Fitness Is an Independent Predictor of Hypertension Incidence among Initially Normotensive Healthy Women
Barlow et al.
Am J Epidemiol 2006;163:142-150.
ABSTRACT | FULL TEXT  

Association Between Protein Intake and Blood Pressure: The INTERMAP Study
Elliott et al.
Arch Intern Med 2006;166:79-87.
ABSTRACT | FULL TEXT  

Management of Hypertension in Diabetes
Stults and Jones
Diabetes Spectr. 2006;19:25-31.
ABSTRACT | FULL TEXT  

Medical Nutrition Therapy for Hypertension and Albuminuria
Franz
Diabetes Spectr. 2006;19:32-38.
ABSTRACT | FULL TEXT  

Treatment of Hypertension: Remaining Issues After the Anglo-Scandinavian Cardiac Outcomes Trial
Kaplan
Hypertension 2006;47:10-13.
FULL TEXT  

Dyslipidemia and the Risk of Incident Hypertension in Men
Halperin et al.
Hypertension 2006;47:45-50.
ABSTRACT | FULL TEXT  

Effects of Protein, Monounsaturated Fat, and Carbohydrate Intake on Blood Pressure and Serum Lipids: Results of the OmniHeart Randomized Trial
Appel et al.
JAMA 2005;294:2455-2464.
ABSTRACT | FULL TEXT  

Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort
Alonso et al.
Am. J. Clin. Nutr. 2005;82:972-979.
ABSTRACT | FULL TEXT  

The Rise In Health Care Spending And What To Do About It
Thorpe
Health Aff (Millwood) 2005;24:1436-1445.
ABSTRACT | FULL TEXT  

Racial Disparities in Hypertension Prevalence, Awareness, and Management
Hertz et al.
Arch Intern Med 2005;165:2098-2104.
ABSTRACT | FULL TEXT  

Job constraints and arterial hypertension: different effects in men and women: the IHPAF II case control study
Radi et al.
Occup. Environ. Med. 2005;62:711-717.
ABSTRACT | FULL TEXT  

Effect of Powdered Fermented Milk with Lactobacillus helveticus on Subjects with High-Normal Blood Pressure or Mild Hypertension
Aihara et al.
J. Am. Coll. Nutr. 2005;24:257-265.
ABSTRACT | FULL TEXT  

Race/Ethnicity, Income, Major Risk Factors, and Cardiovascular Disease Mortality
Thomas et al.
Am. J. Public Health 2005;95:1417-1423.
ABSTRACT | FULL TEXT  

Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial
He et al.
ANN INTERN MED 2005;143:1-9.
ABSTRACT | FULL TEXT  

Modest Salt Reduction Lowers Blood Pressure in Isolated Systolic Hypertension and Combined Hypertension
He et al.
Hypertension 2005;46:66-70.
ABSTRACT | FULL TEXT  

Diets and Cardiovascular Disease: An Evidence-Based Assessment
Parikh et al.
J Am Coll Cardiol 2005;45:1379-1387.
ABSTRACT | FULL TEXT  

Longitudinal study of soy food intake and blood pressure among middle-aged and elderly Chinese women
Yang et al.
Am. J. Clin. Nutr. 2005;81:1012-1017.
ABSTRACT | FULL TEXT  

Daily Life Activity and the Risk of Developing Hypertension in Middle-aged Japanese Men
Nakanishi and Suzuki
Arch Intern Med 2005;165:214-220.
ABSTRACT | FULL TEXT  

Effects of exercise and diet on chronic disease
Roberts and Barnard
J. Appl. Physiol. 2005;98:3-30.
ABSTRACT | FULL TEXT  

Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk)
Khaw et al.
Am. J. Clin. Nutr. 2004;80:1397-1403.
ABSTRACT | FULL TEXT  

Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study
Psaltopoulou et al.
Am. J. Clin. Nutr. 2004;80:1012-1018.
ABSTRACT | FULL TEXT  

The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide
Fields et al.
Hypertension 2004;44:398-404.
ABSTRACT | FULL TEXT  

Hypertensive Therapy: Part II
Franco et al.
Circulation 2004;109:3081-3088.
FULL TEXT  

Population Effects on Individual Systolic Blood Pressure: A Multilevel Analysis of the World Health Organization MONICA Project
Merlo et al.
Am J Epidemiol 2004;159:1168-1179.
ABSTRACT | FULL TEXT  

Diet and blood pressure in 2.5-y-old Danish children
Ulbak et al.
Am. J. Clin. Nutr. 2004;79:1095-1102.
ABSTRACT | FULL TEXT  

Blood Pressure and Risk of Secondary Cardiovascular Events in Women: The Women's Antioxidant Cardiovascular Study (WACS)
Mason et al.
Circulation 2004;109:1623-1629.
ABSTRACT | FULL TEXT  

Relation of Vegetable, Fruit, and Meat Intake to 7-Year Blood Pressure Change in Middle-aged Men: The Chicago Western Electric Study
Miura et al.
Am J Epidemiol 2004;159:572-580.
ABSTRACT | FULL TEXT  

British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary
Williams et al.
BMJ 2004;328:634-640.
FULL TEXT  

Factors Associated With Hypertension Awareness, Treatment, and Control in a Representative Sample of the Chinese Population
Muntner et al.
Hypertension 2004;43:578-585.
ABSTRACT | FULL TEXT  

Reducing the Public Health Burden From Elevated Blood Pressure Levels in the United States by Lowering Intake of Dietary Sodium
Havas et al.
Am. J. Public Health 2004;94:19-22.
ABSTRACT | FULL TEXT  

Pediatric Precursors of Adult Atherosclerosis
Belay et al.
Pediatr. Rev. 2004;25:4-16.
FULL TEXT  

How Far Should Salt Intake Be Reduced?
He and MacGregor
Hypertension 2003;42:1093-1099.
ABSTRACT | FULL TEXT  

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Chobanian et al.
Hypertension 2003;42:1206-1252.
ABSTRACT | FULL TEXT  

Psychosocial Factors and Risk of Hypertension: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Yan et al.
JAMA 2003;290:2138-2148.
ABSTRACT | FULL TEXT  

Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on the Pressure-Natriuresis Relationship
Akita et al.
Hypertension 2003;42:8-13.
ABSTRACT | FULL TEXT  

Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): Resetting the Hypertension Sails
Lenfant et al.
Circulation 2003;107:2993-2994.
FULL TEXT  

Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): Resetting the Hypertension Sails
Lenfant et al.
Hypertension 2003;41:1178-1179.
FULL TEXT  

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report
Chobanian et al.
JAMA 2003;289:2560-2571.
ABSTRACT | FULL TEXT  

Hypertension and Obesity
Najman et al.
Arch Intern Med 2003;163:1114-1115.
FULL TEXT  

Effects of Comprehensive Lifestyle Modification on Blood Pressure Control: Main Results of the PREMIER Clinical Trial
Writing Group of the PREMIER Collaborative Researc
JAMA 2003;289:2083-2093.
ABSTRACT | FULL TEXT  

Factors Associated with Uncontrolled Hypertension in an Affluent, Elderly Population
Inciardi et al.
The Annals of Pharmacotherapy 2003;37:485-489.
ABSTRACT | FULL TEXT  

Lifestyle Modifications to Prevent Hypertension
McGuffin
JAMA 2003;289:843-843.
FULL TEXT  

Lifestyle Modifications to Prevent Hypertension
Logan
JAMA 2003;289:843-843.
FULL TEXT  

Secondary Prevention of Coronary Heart Disease in Women: A Call to Action
Miller and Oparil
ANN INTERN MED 2003;138:150-151.
FULL TEXT  

The Verdict From ALLHAT--Thiazide Diuretics Are the Preferred Initial Therapy for Hypertension
Appel
JAMA 2002;288:3039-3042.
FULL TEXT  

Guidelines: Primary Prevention of Hypertension
Journal Watch Cardiology 2002;2002:1-1.
FULL TEXT