Although the Eighth Joint National Committee recently recommended raising the systolic blood pressure (SBP) goal from 140 mm Hg to 150 in people 60 years of age and older without diabetes mellitus or chronic kidney disease, five members of the panel disagreed in a viewpoint published online Jan. 14 in Annals of Internal Medicine. They argued that there was not sufficient evidence to increase the target SBP.
In their viewpoint, Jackson T. Wright Jr., MD, PhD, of University Hospitals Case Medical Center in Cleveland, and colleagues summarized the evidence and their rationale for supporting the current SBP target in these patients.
The authors explained that blood pressure control has improved considerably over the past decade and that among treated and untreated adults with high blood pressure aged 60 or older, average SBPs have been on the decline. By increasing the SBP goal, the SBPs of treated adults in this age group might increase while the change might leave about half of the untreated hypertensive adults in this age group without treatment.
Additionally, the higher SBP target would affect some groups of people at highest risk for cardiovascular disease (CVD), including African Americans, those with numerous risk factors for cardiovascular disease not including diabetes or chronic kidney disease and those with cardiovascular disease.
They also argued that existing evidence does not support raising the SBP goal.
“In the absence of definitive evidence defining the optimum SBP target, observational studies and RCT [randomized clinical trial] data that the panel did not systematically review more strongly support the SBP goal of less than 140 mm Hg, especially in high-risk individuals,” they wrote.
Another argument they made was that increasing the target could potentially reverse the trend of decreasing stroke mortality in adults 60 and older.
“Because of the overall evidence, including the RCT data reviewed by the panel, and the decrease in CVD mortality, we concluded that the evidence for increasing a blood pressure target in high-risk populations should be at least as strong as the evidence required to decrease the recommended blood pressure target,” they concluded.