Abstract 17173: Incidence of Cardiovascular Disease in Individuals Affected by Recent Changes in Blood Pressure Treatment Guidelines
Introduction: The Eighth Joint National Committee (JNC 8) recently recommended important changes to blood pressure (BP) management. Specifically, JNC 8 endorsed relaxing systolic BP (SBP) targets for adults aged ≥60 years and individuals with diabetes or kidney disease. We compared the incidence of cardiovascular disease (CVD) in individuals whose BP management might be affected by these changes.
Hypothesis: We hypothesized that individuals with BP and treatment status consistent with more lenient BP targets (representative of JNC 8) would demonstrate higher incidence of CVD, compared to individuals achieving more aggressive targets (representative of JNC 7).
Methods: We included visits from three examination cycles of the Framingham Offspring Study (11,237 visits, mean age 46 years, 53% women), and assigned participants to one of five categories based on resting BP, treatment status, and recommendations according to JNC 7 and JNC 8 guidelines. Cox proportional hazards regression was used to assess if time to CVD varied by BP category.
Results: During follow-up (mean 11.0 years), there were 1047 incident CVD events (8.5/1000 person-years). Using the group free of hypertension as referent, we observed the highest incidence of CVD in those with treated SBP 140-149 mm Hg and diastolic BP (DBP) <90 mm Hg (multivariable-adjusted hazard ratio [HR] 3.53, p<0.0001), which was consistent among those aged <60 years (HR 3.51, p=0.0004) and ≥60 years (HR 2.74, p<0.0001), Table. Participants with untreated SBP 140-149 mm Hg and DBP <90 mm Hg also had increased CVD risk overall (multivariable-adjusted HR 1.88, p<0.0001), as well as within those aged <60 years (HR 2.25, p=0.0002), but not those ≥60 years (HR 1.28, p=0.81).
Conclusions: Individuals with SBP 140-149 mm Hg and DBP <90 mm Hg have increased risk of CVD, and the risk is especially high for those on treatment. Although observational, our findings may help to address concerns regarding changes proposed by the JNC 8 guidelines.
Author Disclosures: M. Nayor: None. M.D. Stevenson: None. V. Xanthakis: None. M.G. Larson: None. R.S. Vasan: None.
- © 2015 by American Heart Association, Inc.