New blood pressure guidelines may lead to under treatment of older adults

Approximately one-third of U.S. adults have hypertension (or high blood pressure). Treatment of this condition is essential to the prevention of cardiovascular disease (CVD), the #1 killer of both men and women in the country. In 2014, the Joint National Committee (JNC) released the eighth update to the blood pressure guidelines (JNC8P). These guidelines included a controversial decision to change the blood pressure goal for adults 60 years of age or older. The JNC8P guidelines set a less stringent goal blood pressure of < 150/90 mmHg for individuals 60 years of age or older compared to the previous <140/90 mmHg goal. The guidelines also encouraged a more lenient goal for those with chronic kidney disease (CKD) or diabetes of < 140/90 mmHg (the previous goal was < 130/90 mmHg).

Michael Miedema, MD of the Minneapolis Heart Institute Foundation and principal investigator in a recently published study said, "The concern surrounding less stringent guidelines is that under treatment ofhypertensionmay lead to an increase in the risk for heart attacks and strokes. One of the main risk factors for CVD is age, so under treating older adults may lead to a significant increase in CVD events. This study has helped us understand the potential magnitude of the impact of these new guidelines."

The study reviewed the Atherosclerosis Risk in Communities (ARIC) cohort, a longitudinal study ofcardiovascular diseasesponsored by the National Heart, Lung, and Blood Institute, to understand the prevalence of blood pressure control and use of antihypertensive medications in aging black and white individuals. Of the over 6,000 individuals included in the study, findings suggest that 16.6 percent (approximately 1 in 6) of participants would be reclassified as having "at goal" blood pressure under the new guidelines with rates similar across black and white individuals. According to Dr. Miedema, "The less stringent blood pressure 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 blood pressure may reduce their risk for a heart attack and stroke." Additionally, the study also revealed that, despite more lenient goals and frequent use of antihypertensive medications, more than 20 percent of the aging cohort remained above JNC8P goals. Dr. Miedema commented, "Our study showed that 1 in 5 adults were not at goal blood pressure by either new or older guidelines. Regardless of what the exactblood pressuregoal should be, we clearly need to continue efforts at improving the detection and control of hypertension."

Full study findings have been published online inHypertensionand will be published in print in the September 2015 issue ofHypertension.