title: Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.
abstract: The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth 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 Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth 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 mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.). mdm307@mail.harvard.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Miedema
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Faye L
authors.initials: FL
authors.lastname: Lopez
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, MN (M.D.M.); Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis (F.L.L., A.R.F.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Epidemiology (J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.); and Baylor College of Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D044465:White People
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; diabetes mellitus; epidemiology; hypertension; standards