The Joint National Committee (for purists, AKA “the group originally assigned to create JNC8”) suggests that for persons aged ≥ 60 years, systolic blood pressure (SBP) should be lowered to < 150 mmHg. Is this the right number? After all, the relationship between SBP and cardiovascular disease (CVD) demonstrated in epidemiologic observational studies appears to be linear, so might CVD risk be better reduced by achieving lower SBP than simply “< 150 mmHg”?
To address this question, Mohebi et al followed a population of senior citizens (n = 1845) for approximately 10 years, looking at the hazard ratio for suffering a CVD event or mortality when comparing various levels of BP to a BP of 120/80 (which they designate as ideal BP). All study participants were aged ≥ 60 years at baseline (mean age = 66 years), and ostensibly free of CVD.
In this population, persons with prehypertension were not at demonstrably greater risk than persons with ideal BP. However, when SBP was 140-150 mmHg, risk for CV events was more than 1.5 times as great as SBP 120 (even though there was no increased mortality signal).
Based on these observations, the authors suggest that the risk of CV events even at a SBP of 140-150 is substantially greater than “ideal BP.” At the same time, they acknowledge that clinical trials in senior citizens attempting to clarify whether lower BP levels will improve outcomes more than simply attaining < 150 mmHg have been inconsistent.
Evidence-based updates in primary care medicine.
Supplement to Clinical Cardiology Alert, Critical Care Alert, Hospital Medicine Alert, Infectious Disease Alert, Neurology Alert, OB/GYN Clinical Alert, Primary Care Reports.
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