November 9, 2015 – Jackson Heart Study findings support review of 2014 hypertension guidelines.
The 2014 Joint National Committee hypertension guidelines recommend a blood pressure goal of less than 150/90 for people aged over 60 years without diabetes or chronic kidney disease. However, these recommendations, which are less stringent than earlier guidelines, are based only on randomized controlled trial data. Their application in African-American patients, who are poorly represented in trials and disproportionately affected by hypertension and its health impacts, were unknown.
The Jackson Heart Study – a prospective, community-based, observational study of African-American participants in the southern United States – is investigating risk factors for cardiovascular disease. Participants completed three study visits from 2000-2013, and outcomes were assessed through 2011. In this cohort, 60 percent had hypertension at baseline, and 83 percent were treated with anti-hypertensive medication. A mortality analysis included 5,280 patients, and a heart failure hospitalization analysis included 5,172 participants.
Over nine years of follow-up, higher systolic blood pressure was associated with increased risk of mortality among all participants, while an increase in diastolic blood pressure was associated with reduced mortality only in participants aged 60 years or older. The association between increasing systolic blood pressure and mortality was stronger in participants aged under 60 than in those aged 60 years and above. Blood pressure was not associated with heart failure hospitalization.
“Our observational findings suggest that there are negative health impacts in African Americans at blood pressure levels below the liberalized 2014 guideline treatment goals,” said lead author Tiffany C. Randolph, MD, of the DCRI. “These results are in line with initial findings from the randomized Systolic Blood Pressure Intervention Trial, also being presented at AHA, that a lower blood pressure target greatly reduces cardiovascular complications and deaths in older adults. The 2014 treatment goals should be reexamined based on this new information.”
The study results were presented on Monday at the 2015 American Heart Association Scientific Sessions.
Other Duke and DCRI co-authors were Melissa A. Greiner, MS; Chidiebube Egwim; Adrian F. Hernandez, MD, MHS; Kevin L. Thomas, MD; Lesley H. Curtis, PhD.; Robert J. Mentz, MD; and Emily C. O’Brien, PhD.