title: Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study.
abstract: In 2014, the Eighth Joint National Committee revised the target maximum systolic blood pressure (SBP) from 140 to 150 mm Hg in patients aged ≥60 years without diabetes mellitus or chronic kidney disease. The evidence from cohort studies supporting this change was sparse, particularly among US minority populations. In the Northern Manhattan Study, 1750 participants aged ≥60 years and free of stroke, diabetes mellitus, and chronic kidney disease had SBP measured at baseline and were annually followed up for incident stroke. Mean age at baseline was 72±8 years, 63% were women, 48% Hispanic, 25% non-Hispanic white, and 25% non-Hispanic black. Among all participants, 40% were on antihypertensive medications; 43% had SBP <140 mm Hg, 20% had 140 to 149 mm Hg, and 37% had ≥150 mm Hg. Over a median follow-up of 13 years, 182 participants developed stroke. The crude stroke incidence was greater among individuals with SBP≥150 mm Hg (10.8 per 1000 person-years) and SBP 140 to 149 (12.3) than among those with SBP<140 (6.2). After adjusting for demographics, vascular risk factors, diastolic BP, and medication use, participants with SBP 140 to 149 mm Hg had an increased risk of stroke (hazard ratio, 1.7; 95% confidence interval, 1.2-2.6) compared with those with SBP <140 mm Hg. The increased stroke risk was most notable among Hispanics and non-Hispanic blacks. Raising the SBP threshold from 140 to 150 mm Hg as a new target for hypertension treatment in older individuals without diabetes mellitus or chronic kidney disease could have a detrimental effect on stroke risk reduction, especially among minority US populations.
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.).
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.).
authors.forename: David
authors.initials: D
authors.lastname: Della-Morte
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.).
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.).
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From the Department of Neurology (C.D., D.D.-M., T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and John T. McDonald Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.), Department of Systems Medicine, School of Medicine, University of Rome, Rome, Italy (D.D.-M.); and BioBIM - Multidisciplinary Interinstitutional BioBank, IRCCS San Raffaele Pisana, Rome, Italy (D.D.-M.). rsacco@med.miami.edu.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cardiovascular diseases; continental population groups; epidemiology; stroke
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