April 20, 2026Journal of the American College of Cardiology75 citations
View Full Paper2014 Eighth Joint National Committee Panel Recommendation for Blood Pressure Targets Revisited
Key Result
Achieving a systolic BP target of <140 mm Hg in hypertensive CAD patients ≥60 years old reduced the primary composite outcome compared to 140-<150 mm Hg (9.36% vs 12.71%; p<0.0001).
Key Points
- This study aims to evaluate the optimal blood pressure target in patients aged 60 and older with coronary artery disease.
- Patients aged 60+ with coronary artery disease and baseline systolic BP >150 mm Hg were randomized to receive either atenolol/hydrochlorothiazide or verapamil-SR/trandolapril.
- Participants were categorized based on achieved systolic BP: <140 mm Hg, 140-<150 mm Hg, and ≥150 mm Hg.
- Outcomes were evaluated using both unadjusted and propensity score-adjusted models over 22,308 patient-years of follow-up.
- Group 1 (<140 mm Hg) had the lowest primary outcome rates (9.36%) compared to group 2 (12.71%) and group 3 (21.32%; p < 0.0001).
- Compared to group 1, group 2 had increased cardiovascular mortality risk (HR: 1.34; 95% CI: 1.01 to 1.77; p = 0.04) and group 3 had increased risk of multiple outcomes (p < 0.0001).
- Achieving BP <140 mm Hg offered greater benefits than the JNC-8 recommended target of 140 to <150 mm Hg.
Study Design
Type
RCT (n=8,354)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does achieving a systolic BP target of 140 to <150 mm Hg compared to <140 mm Hg improve cardiovascular outcomes in patients ≥60 years of age with CAD?
P
Population
8,354 patients ≥60 years of age with coronary artery disease (CAD) and baseline systolic BP >150 mm Hg from the INVEST (INternational VErapamil SR Trandolapril STudy) trial.
I
Intervention
Achieved on-treatment systolic BP of 140 to <150 mm Hg (JNC-8 recommended target) or ≥150 mm Hg.
C
Comparator
Achieved on-treatment systolic BP of <140 mm Hg (previously recommended target).
O
Outcome
First occurrence of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke.composite
In hypertensive patients ≥60 years of age with CAD, achieving a systolic BP target of <140 mm Hg is associated with significantly lower risks of cardiovascular mortality and stroke compared to the JNC-8 recommended target of 140 to <150 mm Hg.
Main Result
Absolute Event Rate: 9.36% vs 12.71%
p-value: p=<0.0001
Abstract
BACKGROUND: The 2014 Eighth Joint National Committee panel recommendations for management of high blood pressure (BP) recommend a systolic BP threshold for initiation of drug therapy and a therapeutic target of 150 mm Hg randomized to a treatment strategy on the basis of either atenolol/hydrochlorothiazide or verapamil-SR (sustained release)/trandolapril in INVEST (INternational VErapamil SR Trandolapril STudy) were categorized into 3 groups on the basis of achieved on-treatment systolic BP: group 1, <140 mm Hg; group 2, 140 to <150 mm Hg; and group 3, ≥150 mm Hg. Primary outcome was first occurrence of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke. Secondary outcomes were all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, nonfatal stroke, heart failure, or revascularization, tabulated separately. Outcomes for each group were compared in unadjusted and multiple propensity score-adjusted models. RESULTS: Among 8,354 patients included in this analysis with an accumulated 22,308 patient-years of follow-up, 4,787 (57%) achieved systolic BP of <140 mm Hg (group 1), 1,747 (21%) achieved systolic BP of 140 to <150 mm Hg (group 2), and 1,820 (22%) achieved systolic BP of ≥150 mm Hg (group 3). In unadjusted models, group 1 had the lowest rates of the primary outcome (9.36% vs. 12.71% vs. 21.32%; p < 0.0001), all-cause mortality (7.92% vs. 10.07% vs. 16.81%; p < 0.0001), cardiovascular mortality (3.26% vs. 4.58% vs. 7.80%; p < 0.0001), MI (1.07% vs. 1.03% vs. 2.91%; p < 0.0001), total stroke (1.19% vs. 2.63% vs. 3.85%; p <0.0001), and nonfatal stroke (0.86% vs 1.89% vs 2.86%; p<0.0001) compared with groups 2 and 3, respectively. In multiple propensity score-adjusted models, compared with the reference group of <140 mm Hg (group 1), the risk of cardiovascular mortality (adjusted hazard ratio HR: 1.34; 95% confidence interval CI: 1.01 to 1.77; p = 0.04), total stroke (adjusted HR: 1.89; 95% CI: 1.26 to 2.82; p = 0.002) and nonfatal stroke (adjusted HR: 1.70; 95% CI: 1.06 to 2.72; p = 0.03) was increased in the group with BP of 140 to <150 mm Hg, whereas the risk of primary outcome, all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, and nonfatal stroke was increased in the group with BP ≥150 mm Hg. CONCLUSIONS: In hypertensive patients with CAD who are ≥60 years of age, achieving a BP target of 140 to <150 mm Hg as recommended by the JNC-8 panel was associated with less benefit than the previously recommended target of <140 mm Hg.
Expert Takes6 quotes
1/6
“Given the size and underlying cardiovascular risk of the population affected by the changes in the 2014 panel recommendations, close monitoring will be required to assess changes in practice patterns, blood pressure control, and – importantly – any changes in cardiovascular morbidity and mortality.”
William B. Borden, Cardiologist, George Washington UniversityGeorge Washington Universityauto_pipelineView source
Cite This Study
Bangalore et al. (Fri,) conducted a rct in Hypertension with coronary artery disease (n=8,354). Achieved systolic BP <140 mm Hg vs. Achieved systolic BP 140 to <150 mm Hg and ≥150 mm Hg was evaluated on First occurrence of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke (p=<0.0001). Achieving a systolic BP target of <140 mm Hg in hypertensive CAD patients ≥60 years old reduced the primary composite outcome compared to 140-<150 mm Hg (9.36% vs 12.71%; p<0.0001).