Growing Uncertainty in BP Treatment Targets
A new study has found that blood pressure (BP) below and above the current Eighth Joint National Committee (JNC 8) recommended targets is linked to an increased risk of renal disease and mortality. The study results were published in the Journal of the American College of Cardiology.
This retrospective cohort study assessed 398,419 patients ≥18 years of age treated for hypertension between January 1, 2006 and December 31, 2010 to compare risk of mortality and end-stage renal disease (ESRD). Thirty percent of the patients also had a diagnosis of diabetes.
Mortality occurred in approximately 6.3% of patients and ESRD in 1.2%. Adjusted hazard ratios (95% CI) for composite mortality/ESRD in systolic blood pressure (SBP) <110, 110–119, 120–129, 140–149, 150–159, 160–169, and ≥170mmHg compared with 130–139mmHg were 4.1 (95% CI: 3.8–1.3), 1.8 (95% CI: 1.7–1.9), 1.1 (95% CI: 1.1–1.1), 1.4 (95% CI: 1.4–1.5), 2.3 (95% CI: 2.2–2.5), 3.3 (95% CI: 3.0–3.6), and 4.9 (95% CI: 4.4–5.5), respectively. Diastolic blood pressure (DBP) of <60mmHg and >79 mmHg and SBP <130mmHg and >139mmHg were associated with the highest risk of renal disease and mortality.
Patients with SBP between 120–129mmHg had a 10% greater risk of renal disease or mortality vs. those with SBP between 130–139mmHg; those with SBP from 140–149mmHg had a 40% greater risk. The lowest risk was seen at 137mmHg and 71mmHg, 131mmHg and 69mmHg for patients with diabetes <70 years of age, and 140mmHg and 70mmHg for diabetic patients ≥70 years of age for SBP and DBP respectively.
The JNC 8 recommendation for target BP in the general population aged ≥60 years after initiating pharmacological treatment to lower BP is SBP <150mmHg and DBP <90mmHg, and SPB <140mmHg and DBP <90mmHg for those <60 years of age and patients with diabetes ≥18 years of age. The results of this study add to the questions regarding BP targets, particularly risk with SBP <130mmHg.
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