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Study Challenges Controversial Blood Pressure Targets for Older Patients

Results Show Less Benefit for Patients Compared to Previous Targets

Confused about the new blood pressure recommendations and what you should be aiming for? You’re not alone.
A new study led by researchers in the Cardiac and Vascular Institute at NYU Langone Medical Center found that current blood pressure recommendations for people aged 60 years and older who suffer from coronary artery disease (CAD) may not be optimal compared to the previous guidelines. The findings, based on analysis of more than 8,000 patient records, appear in the August 18 online issue of the Journal of the American College of Cardiology (JACC).
“Our results showed that the JNC-8 blood pressure targets are associated with less benefit for patients and in fact may put them at higher risk for stroke and even death when compared with previous lower targets,” said lead author Sripal Bangalore, MD, associate professor of Medicine in the Leon H. Charney Division of Cardiology at NYU Langone. “We think this is a cause for concern because the new guidelines are being recommended for large populations of patients who are at increased risk.”
Bangalore said his team undertook the new analysis because of wide disagreement among clinicians about optimal blood pressure goals among the elderly, and the need for clarity.
The controversial guidelines released in December 2013 by the Eighth Joint National Committee (JNC 8) Panel on the management of adult hypertension recommended relaxing the threshold for treatment initiation and blood pressure targets from previous guidelines for elderly patients. The JNC 8 recommended a systolic blood pressure threshold for initiation of drug therapy and a therapeutic target of less than 150/90 mmHg in patients aged 60 years or older -- a departure from the previous, more aggressive targets of less than 140/90 mmHg recommended by JNC 7.
The NYU Langone-led study, an observational analysis of more than 8,000 patients enrolled in the INternational VErapamil-Trandolapril STudy (INVEST) trial, evaluated the optimal blood pressure in patients aged 60 years or older with coronary artery disease. The patients studied were separated into three groups:
• those who achieved systolic blood pressure of less than 140 mmHg (57 percent)
• those who achieved systolic blood pressure of 140 mmHG to less than 150 mmHg (24 percent), and
• those who achieved systolic blood pressure of 150 mmHg or greater (42 percent).
Results showed that those who achieved a systolic blood pressure of less than 140 mmHg had the lowest rates of mortality, cardiovascular mortality, fatal and nonfatal heart attacks, and fatal and nonfatal stroke compared to groups that achieved a systolic blood pressure of greater than or equal to 140 mmHg, without any increase in adverse experiences.
Moreover, outcomes of those targeted for the JNC 8 recommended blood pressure of 140 to 150 mm Hg, were associated with increased risks of cardiac death, stroke, and non-fatal stroke compared to the group that achieved the lower systolic blood pressure goal of less than 140 mmHg.
“The findings in the study clearly show that relaxing blood pressure targets for elderly patients, who are at increased risk of stroke and cardiovascular death, could have far reaching consequences for a large proportion of patients with coronary artery disease,” said Dr. Bangalore. “These patients are most at risk for hypertension-related adverse outcomes, and we need to ensure that we are treating them optimally.”

Source Newsroom: NYU Langone Medical Center
Journal of the American College of Cardiology



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