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• W2033080618 abstract "versy was generated by the JNC 8 panel that suggested that elevated blood pressure up to 150 mm Hg systolic need not be treated in patients over 60 years of age. This has generated considerable heated discussion among those who write guidelines, practitioners, and even members of the JNC 8 panel who chose to write a dissenting minority report. 2,3 This issue of JASH contains two papers that address the issue of the point at which BP should be treated in patients over 60 years of age. One paper presented the results of a large 10-year follow-up study that showed that there was a risk over 140 mm Hg. The other paper presented data that appears to support the JNC 8 recommendation. We shall examine each of these papers in greater detail. The study by Mohebi et al 4 was of 1845 subjects over age 60 years of age who were identified in 1999‐2001 as part of a larger study of 15,005 subjects in Tehran, Iran. They were followed for a median of 10 years. They were divided into four groups: Optimal (systolic blood pressure [SBP] 90 mm Hg); Hypertensive (SBP � 150 mm Hg or DBP � 90 mm Hg or taking antihypertensive medications). They were followed closely and outcomes events were carefully defined and analyzed. During the 10 years, 380 cases of cardiovascular disease (CVD) and 305 cases of incident coronary heart disease (CHD) were identified. The prehypertensive group was not different for incident CVD, CHD, or cardiovascular mortality from the Optimal group. Group 3, the one generating the most controversy by the JNC 8 report, was at a significantly higher risk of incident CVD and CHD but not total mortality or CVD mortality. The hypertensive group did have a higher risk for incident CVD, CHD and CVD mortality, and a marginally increased risk of total mortality events. The study was limited in several ways. First, BP was measured twice on the initial visit, and the results were averaged. Second, the study population was derived from a defined area of Tehran that may not even be representative of all of Tehran, let alone Iran or areas outside of the Middle East. For example, only 5.4%‐10.1% of groups 2, 3, and 4 smoked, and they were, in general, not obese or diabetic. The study by Rock et al 5 followed a smaller group of subjects (317) with an average age of 59.2 years who were 81% men and who were followed for a median of 6 years. Over this period, 19 patients had a new coronary artery event, and three had a cerebrovascular event. BP was determined by 24-hour ambulatory BP monitoring. There were 195 patients with SBP <140 mm Hg, 70 between 140 and 150 mm Hg, and 52 were � 150 mm Hg. The investigators did not find a difference in cardiovascular events" @default.
• W2033080618 created "2016-06-24" @default.
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• W2033080618 date "2014-07-01" @default.
• W2033080618 modified "2023-09-27" @default.
• W2033080618 title "Attempts to define the risk of elevated blood pressure" @default.
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• W2033080618 doi "https://doi.org/10.1016/j.jash.2014.03.327" @default.
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