Some panel members are speaking out against the decision to raise the threshold at which older adults begin taking medication to control their blood pressure. In a commentary published in the Jan. 14 issue of the Annals of Internal Medicine, some members of the Eighth Joint National Committee, or JNC 8, explain why they voted against relaxing systolic blood pressure targets to 150 mmHg for patients aged 60 and older without diabetes or chronic kidney disease (CKD).
Lead author Jackson Wright, Jr., MD, PhD, Director of the Clinical Hypertension Program at University Hospitals Case Medical Center and Professor of Medicine at Case Western Reserve University School of Medicine, said there was consensus on all of the guidelines issued by the JNC8 except for this one particular guideline about systolic blood pressure.
"We believed that evidence was insufficient to increase the systolic blood pressure goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for cardiovascular disease (CVD) and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years," said Dr. Wright.
"The major concern is that by recommending higher blood pressure targets, for both the initiation of treatment and the treatment targets, we would, in fact, be putting these high risk patients at greater risk for complications of hypertension," he said.
He said that people over the age of 60 are 50 times more likely to die from strokes and 35 times more likely to die from heart attacks and coronary artery disease than people under the age of 60.
Dr. Wright explained that the original paper was not the place, nor did it have the room, for the explanation, thus the need for the Annals commentary.
"We are simply providing the evidence related to that disagreement. Others will have to judge whether or not they will abide by the recommendation of 140 mm Hg or abide by the recommendation of the majority of the guideline panel, which is a systolic blood pressure target of 150," said Dr. Wright.
- Jackson T. Wright Jr., Lawrence J. Fine, Daniel T. Lackland, Gbenga Ogedegbe, Cheryl R. Dennison Himmelfarb. Evidence Supporting a Systolic Blood Pressure Goal of Less Than 150 mm Hg in Patients Aged 60 Years or Older: The Minority View. Annals of Internal Medicine, 2014; DOI: 10.7326/M13-2981
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