Millions of Seniors Achieved Goal for Blood Pressure
Overnight, Reports JAMA
Seniors age 60 and up were focus of 2014 guidelines
that set treatment for hypertension at 150-over-90 mm Hg, rather than
March 30, 2014 A new estimate projects that 13.5
million U.S. adults primarily seniors age 60 or older will would now
be considered as having achieved their goal for blood pressure, as
defined by the 2014 BP guidelines announced last December. Almost six
million adults can relax, too, since they will no longer be classified
as needing hypertension medication, according to a JAMA study
released online to coincide with the 2014 American College of Cardiology
These older American age 60 and over were the focus
2014 guidelines that set treatment for hypertension at
150-over-90 mm Hg, rather than 140/90, which still remains the defined
level for high blood pressure.
Ann Marie Navar-Boggan, M.D., Ph.D., of Duke
University Medical Center, Durham, N.C., and colleagues quantified the
proportion of adults potentially affected by the updated 2014
recommendations, compared to the previous guideline, issued nearly 10
years ago (Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure [JNC 7]).
One of three editorials
(below news story) in JAMA says it is likely that there will be
considerable controversy in hypertension treatment for the foreseeable
future; high blood pressure still 140/90 - Dec. 18, 2013
The researchers used data from the National Health
and Nutrition Examination Survey (NHANES) between 2005 and 2010 (n =
16,372), and evaluated hypertension control and treatment
recommendations for U.S. adults.
The new guideline proposed less restrictive BP
targets for adults 60 years of age or older and for those with diabetes
and chronic kidney disease.
Seniors 60-Plus Most Affected by New Expanded
Guidelines for Statin Use
Almost 13 million more Americans to be eligible for
statins; 8.3 million would be people over the age of 60, says Duke
March 20, 2014 An additional 12.8 million in U.S.
may soon be taking statins to prevent cardiovascular disease, including
stroke, due to new guidelines expanding the criteria for use to include
people with an elevated 10-year risk. The most affected will be seniors
between the ages of 60 and 75 without cardiovascular disease - 87.4
percent of men and 53.6 percent of women will fall within the new
The increase is much more pronounced among adults
free of cardiovascular disease who are over age 60, with 77 percent
recommended for statin use under the new guidelines vs. 48 percent under
the previous standards. Read more...
The authors estimate that the proportion of younger
adults (18-59 years) in the U.S. considered to have treatment-eligible
hypertension would be decreased from 20.3 percent under JNC 7 to 19.2
percent under the 2014 BP guideline and from 68.9 percent to 61.2
percent among older adults (≥ 60 years).
Extrapolating these numbers to the population
represented by this NHANES sample (U.S. adults in 2007) translates to a
reduction in 5.8 million adults no longer classified as needing
hypertension medication (70 million under JNC 7 to 64.2 million under
the 2014 BP guideline).
The proportion of adults with treatment-eligible
hypertension who met BP goals also increased slightly for younger
adults, from 41.2 percent under JNC 7 to 47.5 percent under the 2014 BP
guideline, and more substantially for older adults, from 40.0 percent to
The authors estimate that 13.5 million adults not
previously considered to be meeting BP targets would be considered at
goal BP under the new guideline, with the majority affected age 60 years
and older, and many of whom have diabetes, chronic kidney disease, and
Overall, 1.6 percent of U.S. adults 18-59 years of
age and 27.6 percent of adults age 60 years or older were receiving
BP-lowering medication and meeting more stringent JNC 7 targets. These
patients may be eligible for less stringent or no BP therapy with the
2014 BP guideline.
"Public health messaging should target the large
number of adults in the United States with changing recommendations
under new guideline to ensure that new recommendations do not result in
unintended consequences in adults now with 'relabeled' BP status," the
authors write. "Further research is needed to determine how this new
guideline affects overall BP levels attained and to determine the
related effects on cardiovascular disease outcomes."
This research was supported in part by Duke
Clinical Research Institute's research funds and unrestricted grants
from M. Jean de Granpre and Louis and Sylvia Vogel.
Editorial: New Guidelines Establish New Course
An accompanying editorial in JAMA says that these
new guidelines, with their innovations and controversy, have established
a new course.
"Navigating it may be uncomfortable and will
perhaps force clinicians to grapple with issues that have been ignored
for too long. While it is important to advocate for health and promote
healthy environments and behaviors on the broader scale, for medical
decision making, it is even more important to ensure informed choice
with the full participation of the person who will incur the risks and
benefits of the decision, writes Harlan M. Krumholz, M.D., S.M., of the
Yale University School of Medicine, New Haven, Conn..
When viewed through this lens, the controversies
about the guidelines become less contentious and the focus shifts to
refining the evidence and producing better ways to communicate what is
known for decision-making purposes. By directing attention to that
message, already firmly embedded in these guidelines with their bold
recommendations and deference to patient preference, they may have
accomplished more than they ever envisioned."
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