Key result
BP 140-149/<90 mmHg is linked to ~170% higher all-cause death vs <140/90 in older hypertensives.
Why the study?
The JNC-8 recommended systolic BP threshold of ≥150 mmHg and target <150/90 mmHg for patients ≥60 years is not supported by some post-hoc analyses and observational studies.
Does a blood pressure of 140-149/<90 mmHg increase the risk of mortality and cardiovascular events compared to <140/90 mmHg in hypertensive patients aged ≥60 years?
Cohort (n=5,006)
Does a blood pressure of 140-149/<90 mmHg increase the risk of mortality and cardiovascular events compared to <140/90 mmHg in hypertensive patients aged ≥60 years?
Hazard Ratio: 2.698 (95% CI 1.989–3.659)
In older hypertensive patients in rural China, a blood pressure of 140-149/<90 mmHg is associated with significantly higher mortality and cardiovascular events compared to <140/90 mmHg, challenging JNC-8 lenient targets.
Suggests caution with 140-149 mmHg systolic in older hypertensives; leaves open whether stricter targets improve outcomes in trials.
The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥ 150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥ 60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations. In the prospective cohort study, 5006 eligible hypertensive patients aged ≥ 60 years from rural areas of China were enrolled for the present analysis. The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989-3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855-3.935), incident CHD (HR: 3.263; 95% CI: 2.063-5.161), and stroke (HR: 2.334; 95% CI: 1.559-3.945) was still significantly increased in the group with BP of 140-149/<90 mmHg. Older hypertensive patients with BP of 140-149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140-149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥ 60 years in rural areas of China.
No takes yet. Share an insight, caveat, or question.
Zheng et al. (2015) conducted a cohort in Hypertension (n=5,006). Blood pressure of 140-149/<90 mmHg vs. Blood pressure <140/90 mmHg was evaluated on All-cause death (HR 2.698, 95% CI 1.989-3.659). In older hypertensive patients, a blood pressure of 140-149/<90 mmHg was associated with an increased risk of all-cause death (HR 2.698; 95% CI 1.989-3.659) compared to BP <140/90 mmHg.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: