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New Analysis of Old Study Fuels Debate Over Blood Pressure Guidelines — Physician’s First Watch

Medical News |
August 20, 2014

New Analysis of Old Study Fuels Debate Over Blood Pressure Guidelines

By Larry Husten

Edited by Lorenzo Di Francesco, MD, FACP, FHM

An analysis in the Journal of the American College of Cardiology adds to the debate around recent guidelines that recommend raising the therapeutic target for systolic blood pressure in patients aged 60 and older, from 140 mm Hg to 150 mm Hg.

Researchers performed a post-hoc analysis of some 8400 patients who participated in the INVEST trial, were aged 60 or older, and had a baseline systolic BP above 150 mm Hg. Participants were randomized to receive atenolol/hydrochlorothiazide or verapamil-SR/trandolapril.

Compared with patients who achieved BP levels below 140 mm Hg, those who reached 140-149 mm Hg did not have a significant increase in the primary combined endpoint of death, nonfatal MI, or nonfatal stroke, but they did have significant increases in risks for cardiovascular mortality, total stroke, and nonfatal stroke alone. Those reaching 150 mm Hg or higher had significant increases in risks for the primary outcome, all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, and nonfatal stroke.

The authors say their findings reaffirm the more stringent blood pressure target of 140 mm Hg in this population.

NEJM Journal Watch Cardiology's Harlan Krumholz commented: "Unfortunately this study is not designed to test optimal target levels. It may be reflecting adherence rates among the subjects, a characteristic known to affect outcomes even among those [who] were taking placebo. It would be a shame if this article was considered to be strong evidence in the current public dialogue about target levels for blood pressure."

Reader Comments (2)

ROBERT HOPE Physician, Internal Medicine, Melbourne,Australia

No time duration of the trial is given.
Do we have statistics of blood pressure levels of healthy 80 to90 yr
old people with age distribution with their ages.Natural maybe svident in this

sean muldoon, md, mph Physician, Pulmonary Medicine, kindred healthcare

another head scratcher. the editors of JACC find the study well designed, well executed and contributing to our knowledge base, (and therefore worthy of their page and their reader's attention), and the editorialist for NEJM dismisses it. so i am left with yet another example of having to separate signal from noise when people more qualified than i cannot.

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