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New BP guidelines reclassify 1 in 6 older adults as achieving targets
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Under the guidelines developed by members appointed to the Eighth Joint National Committee Guidelines for the management of high BP in aging adults, 1 in 6 patients in a U.S. cohort of representative individuals were reclassified as having BP at goal, according to recent findings.
Researchers evaluated 6,088 participants in the longitudinal Atherosclerosis Risk in Communities (ARIC) study of CVD conducted at four centers in the United States. Participants were interviewed in their homes and received baseline clinical examinations between 1987 and 1989, then underwent four follow-up exams, with the most recent occurring between 2011 and 2013. The mean age of the study participants at the most recent exam was 75.6 years (range, 66-90 years; 58.4% women; 23.2% black).
BP was measured at the 2011-2013 follow-up exam and use of antihypertensive medication was determined for each patient. For this analysis, researchers assessed BP control according to the guidelines set forth by the Seventh Joint National Committee (JNC7) and the panel appointed to the Eighth Joint National Committee (JNC8P). JNC7 guidelines advise a target BP of 130/80 mm Hg for individuals without diabetes or chronic kidney disease (CKD). JNC8P guidelines target a BP of less than 150/90 mm Hg for individuals aged older than 60 years and a goal of 140/90 mm Hg for those with diabetes or CKD.
According to the JNC7 guidelines, 81.9% of the participants had hypertension and 62.8% had achieved their target BP. Of those with BP at-goal according to JNC7 guidelines, 71.2% were taking antihypertensive medications. Based on the JNC8P guidelines, 79.4% of the total study population had achieved their target BP, and 72.7% of these participants were taking antihypertensive drugs. The researchers noted that 16.6%, or approximately 1 in 6 of the participants, were recategorized according to the JNC8P guidelines as having achieved BP control.
Among patients without diabetes or CKD, 11.6% of patients had achieved their target BP according to the JNC8P criteria, but not JNC7. The reclassification rate was higher among patients with diabetes or CKD, with 20.6% of patients identified as at their BP goal according to JNC8P but not JNC7.
“The less stringent BP goals will increase the number who are ‘at goal,’ indicating to the patient and their primary care provider that treatment is not indicated, when in fact treatment of their mildly elevated BP may reduce their risk for a heart attack and stroke,” researcher Michael Miedema, MD, of the Minneapolis Heart Institute Foundation, said in a press release.
Miedema also expressed concern that over 20% of the population had BP above the goals for both JNC7 and JNC8P. “Regardless of what the exact BP goal should be, we clearly need to continue efforts at improving the detection and control of hypertension,” he said in the release. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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