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. 2015 Sep;66(3):474-80.
doi: 10.1161/HYPERTENSIONAHA.115.05560. Epub 2015 Jul 6.

Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study

Michael D Miedema  1 , Faye L Lopez  2 , Michael J Blaha  2 , Salim S Virani  2 , Josef Coresh  2 , Christie M Ballantyne  2 , Aaron R Folsom  2
Affiliations

Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study

Michael D Miedema et al. Hypertension. 2015 Sep.

Abstract

The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.

Keywords: blood pressure; diabetes mellitus; epidemiology; hypertension; standards.

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Figures

Figure 1
Figure 1
The Prevalence of At-Goal Blood Pressure according to JNC7 and JNC8P blood pressure guidelines in black and white individuals stratified by diabetes or chronic kidney disease in 6,088 participants from the 5th visit of the Atherosclerosis Risk in Communities Study, 2011–13. Abbreviations: JNC7 – 7th Joint National Committee, JNC8P – 8th Joint National Committee Panel, DM – Diabetes Mellitus, CKD – Chronic Kidney Disease
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