Public Release: 

New blood pressure guidelines may lead to under treatment of older adults

Michael Miedema, M.D., of the Minneapolis Heart Institute Foundation® leads large scale investigation on the impact of JNC8P blood pressure guidelines on aging US population

Minneapolis Heart Institute Foundation

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IMAGE: Dr. Michael D. Miedema is a cardiologist at the Minneapolis Heart Institute® at Abbott Northwestern Hospital. He heads the Minneapolis Heart Institute Foundation's summer research intern program and has a... view more

Credit: Gerry Yumul, @workingatheart, Minneapolis Heart Institute Foundation

MINNEAPOLIS, MINNESOTA - July 6, 2015 - Approximately one-third of U.S. adults have hypertension (or high blood pressure). Treatment of this condition is essential to the prevention of cardiovascular disease (CVD), the #1 killer of both men and women in the country. In 2014, the Joint National Committee (JNC) released the eighth update to the blood pressure guidelines (JNC8P). These guidelines included a controversial decision to change the blood pressure goal for adults 60 years of age or older. The JNC8P guidelines set a less stringent goal blood pressure of < 150/90 mmHg for individuals 60 years of age or older compared to the previous <140/90 mmHg goal. The guidelines also encouraged a more lenient goal for those with chronic kidney disease (CKD) or diabetes of < 140/90 mmHg (the previous goal was < 130/90 mmHg).

Michael Miedema, MD of the Minneapolis Heart Institute Foundation and principal investigator in a recently published study said, "The concern surrounding less stringent guidelines is that under treatment of hypertension may lead to an increase in the risk for heart attacks and strokes. One of the main risk factors for CVD is age, so under treating older adults may lead to a significant increase in CVD events. This study has helped us understand the potential magnitude of the impact of these new guidelines."

The study reviewed the Atherosclerosis Risk in Communities (ARIC) cohort, a longitudinal study of cardiovascular disease sponsored by the National Heart, Lung, and Blood Institute, to understand the prevalence of blood pressure control and use of antihypertensive medications in aging black and white individuals. Of the over 6,000 individuals included in the study, findings suggest that 16.6 percent (approximately 1 in 6) of participants would be reclassified as having "at goal" blood pressure under the new guidelines with rates similar across black and white individuals. According to Dr. Miedema, "The less stringent blood pressure goals will increase the number who are 'at goal,' indicating to the patient and their primary care provider that treatment is not indicated when in fact treatment of their mildly elevated blood pressure may reduce their risk for a heart attack and stroke." Additionally, the study also revealed that, despite more lenient goals and frequent use of antihypertensive medications, more than 20 percent of the aging cohort remained above JNC8P goals. Dr. Miedema commented, "Our study showed that 1 in 5 adults were not at goal blood pressure by either new or older guidelines. Regardless of what the exact blood pressure goal should be, we clearly need to continue efforts at improving the detection and control of hypertension."

Full study findings have been published online in Hypertension and will be published in print in the September 2015 issue of Hypertension.

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About the Minneapolis Heart Institute Foundation

The Minneapolis Heart Institute Foundation is dedicated to improving people's lives through the highest quality cardiovascular research and education.

  • Scientific Innovation and Research -- Publishing more than 120 peer-reviewed studies each year, MHIF is a recognized research leader in the broadest range of cardiovascular medicine. Each year, cardiologists and hospitals around the world adopt MHIF protocols to save lives and improve patient care.
  • Education and Outreach -- Providing more than 10,000 hours of professional education, MHIF puts research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.

The Minneapolis Heart Institute Foundation's work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital.

Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin.

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