Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: The ARIC Study

摘要

The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly impact the aging US population. We performed a cross-sectional analysis of black and white participants in ARIC who participated in the 5th 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 7th and 8th Joint National Committee thresholds. Of 6,088 participants (mean age 75.6 years [range 66–90], 58.4% female, 23.2% African American), 54.9% had either diabetes or chronic kidney disease. The prevalence of hypertension according to 7^th Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the 8^th 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 or chronic kidney disease (20.6%) compared to individuals without either condition (11.6%). Use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least one antihypertensive medication and 46.7% on 2 or more antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, approximately 1 in 6 individuals were reclassified as having blood pressure at goal by 8^th Joint National Committee guidelines. Despite these less aggressive goals, over 20% remain uncontrolled by the new criteria.