OS 18-08 OPTIMAL BLOOD PRESSURE GOAL FOR THE ELDERLY CHINESE: THE FINDINGS FROM THE NORTHERN SHANGHAI STUDY

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Abstract

Objective:

The Eighth Joint National Committee Panel recommended novel blood pressure (BP) goals for individuals with hypertension, which is still under debate. We therefore assessed patients’ target organ damages in controlled hypertensives defined by the Seventh or Eighth Joint National Committee thresholds (JNC7 and JNC8) in a community-based elderly Chinese population, in order to find the optimal BP goal for the elderly Chinese.

Design and Method:

1599 community-based elderly participants (age > 65 years old) were recruited in the northern Shanghai. Prevalence of hypertension was defined as a systolic and diastolic BP > 140/90 or a previous history of hypertension. Participants were classified by chronic kidney disease (CKD) or diabetes mellitus (DM) to investigate the conditions of their BP control based on both the JNC7 and JNC8. Then participants were categorized into 3 groups, individuals at goal BP by JNC7 (Group1), individuals at goal BP by JNC8 but not by JNC7 (Group2), and individuals not at goal by both guidelines (Group3). Patients’ hypertensive target organ damages as left ventricular mass index (LVMI), pulse wave velocity (PWV), carotid intima-medium thickness (CIMT), left ankle-brachial index (LABI), urinary albumin-creatinine ratio (UACR) and creatinine clearance rate (Ccr) were evaluated.

Results:

According to the JNC7, 48.5% of the entire population were at BP goal, while 67.5% were at-goal by the JNC8, including 19.0% reclassified as at-goal. Compared to Group1, Group2 and Group3 had a significantly greater LVMI (93.10 vs 84.47, 96.54 vs 84.47, p < 0.05), PWV (9.70 vs 8.73, 10.31 vs 8.73, p < 0.05) and CIMT (0.62 vs 0.60, 0.63 vs 0.60, p < 0.05), but had a significantly lower LABI (1.02 vs 1.05, 1.02 vs 1.05, p < 0.05).

Conclusions:

In the community-based elderly Chinese, 32.5% of the entire population remained uncontrolled BP by JNC8, but 19% were reclassified as at-goal. The reclassified group had more target organ damages than the original at-goal group, so BP criteria by JNC7, but not by JNC8, would be more beneficial for the elderly Chinese.

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