The systolic blood pressure (SBP) of elderly people should be kept below 140 mmHg, say researchers who dispute the eighth Joint National Committee (JNC 8) guidelines.
The JNC 8 guidelines give 150 mmHg as an appropriate SBP target for patients aged 60 years or older, citing evidence of no additional benefit with tighter control in this age group.
The authors of the current study – Farzad Hadaegh (Shahid Beheshti University of Medical Sciences, Tehran, Iran) and co-workers – say that the recommendations arose from two randomised controlled trials, but that both studies had fairly short follow-up durations (2 years) and were conducted in Japan. The team suggests that the relatively low overall rate of cardiovascular disease (CVD) in this population over a 2-year period may have concealed the potential benefits of rigorous blood pressure control.
Their study involved 1845 people aged at least 60 years who were followed up for a median of 10 years, during which time 380 people had a first CVD event and 305 had a first coronary heart disease (CHD) event.
The 150 mmHg target for SBP in elderly people represents a relaxation from the JNC 7 target of 140 mmHg. But in the current study, people within this 10 mmHg range (140–149 mmHg) had a significantly increased risk of CVD and CHD relative to those with SBP below 120 mmHg. Their likelihood of having these outcomes was elevated 1.79- and 1.73-fold, respectively, after accounting for confounders including lipid profile, waist circumference, blood glucose and smoking status.
There was no additional risk associated with prehypertension (130–139 mmHg) and the risk increase conferred by SBP of 150 mmHg or higher was similar to that associated with SBP between 140 and 149 mmHg. However, it did confer a 2.15-fold increased risk of CHD mortality, whereas lower SBP was not associated with any mortality outcome.
Contrary to the JNC 8 recommendations, “the results of this study imply that those with systolic blood pressure between 150 mmHg and 140 mmHg are still at elevated risk for CHD events”, say the researchers in the Journal of the American Society of Hypertension. “Future studies are needed to find new therapeutic measures to reduce the risk of this group.”
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