Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study

Chuanhui Dong; David Della-Morte; Tatjana Rundek; Clinton B Wright; Mitchell S V Elkind; Ralph L Sacco

doi:10.1161/HYPERTENSIONAHA.115.06857

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Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study

Journal article

Open access

Peer reviewed

Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study

Chuanhui Dong, David Della-Morte, Tatjana Rundek, Clinton B Wright, Mitchell S V Elkind and Ralph L Sacco

Hypertension (Dallas, Tex. 1979), Vol.67(3), pp.520-526

2016-03

DOI: https://doi.org/10.1161/HYPERTENSIONAHA.115.06857

PMID: 26831192

Abstract

Stroke - prevention & control

Humans

Middle Aged

Risk Factors

Hypertension - drug therapy

Male

Antihypertensive Agents - therapeutic use

Forecasting

Hypertension - physiopathology

Incidence

Stroke - etiology

Hypertension - complications

Female

New York City - epidemiology

Stroke - epidemiology

Aged

Blood Pressure - physiology

Retrospective Studies

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.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.55 Urology & Nephrology - General; 1.55.197 Hypertension
Web Of Science research areas: Peripheral Vascular Disease
ESI research areas: Clinical Medicine

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Title: Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study
Creators: Chuanhui Dong - 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.)
David Della-Morte - 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.)
Tatjana Rundek - 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.)
Clinton B Wright - 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.)
Mitchell S V Elkind - 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.)
Ralph L Sacco - 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
Publication Details: Hypertension (Dallas, Tex. 1979), Vol.67(3), pp.520-526
Publisher: United States
Grant note: M01 RR000645 / NCRR NIH HHS UL1 TR000040 / NCATS NIH HHS R01 NS029993 / NINDS NIH HHS
Academic Unit: Leadership Department; Miller School of Medicine; UMMG Department of Neurology
Language: English
Resource Type: Journal article
PMID: 26831192
Record Identifier: 991031560247302976