Abstract P179: Systolic Blood Pressure and Risk for Cardiovascular Disease Among Adults 60 Years and Older without Diabetes or Chronic Kidney Disease

Abstract

The 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) raised the systolic blood pressure (SBP) threshold for treatment initiation and goal attainment to 150 mmHg in adults 60 years and older without a history of diabetes or chronic kidney disease (CKD). Using data from the nationwide Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, we examined the association between SBP levels and cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among adults ≥60 years of age. We excluded participants with a history of diabetes, CKD, and diastolic blood pressure (DBP) ≥90 mmHg. Baseline REGARDS data were collected during telephone interviews and in-home study visits in 2003 through 2007 and included two blood pressure measurements following a standardized protocol. SBP was categorized as <140 mmHg, 140-149 mmHg, and ≥150 mmHg. Outcomes were identified through December 31, 2012 using primary data collection. Of the 4,618 REGARDS participants taking antihypertensive medication, 593 (12.8%) had SBP 140-149 mmHg and 343 (7.4%) had SBP ≥150 mmHg. After multivariable adjustment, SBP of 140-149 mmHg versus SBP <140 mmHg was not associated with any of the outcomes (Table 1) whereas SBP ≥150 mmHg was associated with an increased risk for CVD and CHD, but not stroke. Of the 5,601 participants not taking antihypertensive medication, 417 (7.5%) had SBP 140-149 mmHg and 181 (3.2%) had SBP ≥150 mmHg. Compared with SBP <140 mmHg, SBP140-149 mmHg but not SBP ≥150 mmHg was associated with an increased risk for CVD, CHD, and stroke. In summary, SBP between 140-149 mmHg was associated with CVD-related outcomes in untreated, but not treated individuals. These data suggest using different thresholds for antihypertensive treatment initiation and goal attainment among individuals ≥60 years of age without a history of diabetes or CKD, with DBP ≥90 mmHg may be safe.