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Stroke risk in older adults declines when systolic BP less than 140 mm Hg
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Confirming previously presented results, in adults aged at least 60 years, systolic BP less than 140 mm Hg confers a reduced risk for stroke, according to data from the Northern Manhattan Study.
The findings may have implications for the recommendations made by the panel convened for the Eighth Joint National Committee (JNC 8), which advocated treatment of high BP in patients aged at least 60 years without diabetes or chronic kidney disease when systolic BP reached 150 mm Hg or higher.
“We started this analysis very soon after the [panel convened for JNC 8’s recommendations] came out ... because we were concerned about the recommendation’s potential effect on stroke prevention,” Ralph L. Sacco, MD, MS, FAHA, FAAN, professor and chair of neurology at the University of Miami Miller School of Medicine and past president of the American Heart Association, said in a press release.
Ralph L. Sacco
The researchers presented their initial findings at the 2015 International Stroke Conference.
Sacco and colleagues analyzed 1,750 participants from the Northern Manhattan Study aged at least 60 years without stroke, diabetes or chronic kidney disease at baseline (mean age, 72 years; 63% women; 48% Hispanic; 40% assigned antihypertensive medications).
Lower BP, lower stroke risk
The outcome of interest was stroke. Median follow-up was 13 years, during which 182 participants had a stroke.
At baseline, 43% of participants had systolic BP less than 140 mm Hg, 20% had systolic BP 140 mm Hg to 149 mm Hg and 37% had systolic BP of at least 150 mm Hg, the researchers reported.
Crude incidence of stroke was lower in those with systolic BP less than 140 mm Hg (6.2 per 1,000 person-years) than in those with systolic BP 140 mm Hg to 149 mm Hg (12.3 per 1,000 person-years) and those with systolic BP of at least 150 mm Hg (10.8 per 1,000 person-years).
When the researchers adjusted for demographics, vascular risk factors, diastolic BP and medication use, they found that people with systolic BP 140 mm Hg to 149 mm Hg had increased risk for stroke compared with those with systolic BP less than 140 mm Hg (HR = 1.72; 95% CI, 1.15-2.57).
Subgroup analyses
The elevated risk in people with systolic BP 140 mm Hg to 149 mm Hg was more pronounced in Hispanics (HR = 2.61; 95% CI, 1.35-5.07) and non-Hispanic blacks (HR = 1.93; 95% CI, 0.93-4.03) than in non-Hispanic whites (HR = 0.85; 95% CI, 0.37-1.95), and more pronounced in women (HR = 1.98; 95% CI, 1.22-3.24) than in men (HR = 1.33; 95% CI, 0.65-2.72), according to the researchers.
“The findings suggest one should not liberalize or change the treatment threshold for [BP] in people older than 60 without chronic kidney disease or diabetes,” Sacco said in the release. “For stroke prevention, maintaining a [BP] target of 140 mm Hg is important.”
The AHA and the American College of Cardiology have announced plans to publish a new set of BP guidelines in 2016. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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